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Title: Gated CT imaging using a free-breathing respiration signal from flow-volume spirometry

Abstract

Respiration-induced tumor motion is known to cause artifacts on free-breathing spiral CT images used in treatment planning. This leads to inaccurate delineation of target volumes on planning CT images. Flow-volume spirometry has been used previously for breath-holds during CT scans and radiation treatments using the active breathing control (ABC) system. We have developed a prototype by extending the flow-volume spirometer device to obtain gated CT scans using a PQ 5000 single-slice CT scanner. To test our prototype, we designed motion phantoms to compare image quality obtained with and without gated CT scan acquisition. Spiral and axial (nongated and gated) CT scans were obtained of phantoms with motion periods of 3-5 s and amplitudes of 0.5-2 cm. Errors observed in the volume estimate of these structures were as much as 30% with moving phantoms during CT simulation. Application of motion-gated CT with active breathing control reduced these errors to within 5%. Motion-gated CT was then implemented in patients and the results are presented for two clinical cases: lung and abdomen. In each case, gated scans were acquired at end-inhalation, end-exhalation in addition to a conventional free-breathing (nongated) scan. The gated CT scans revealed reduced artifacts compared with the conventional free-breathing scan.more » Differences of up to 20% in the volume of the structures were observed between gated and free-breathing scans. A comparison of the overlap of structures between the gated and free-breathing scans revealed misalignment of the structures. These results demonstrate the ability of flow-volume spirometry to reduce errors in target volumes via gating during CT imaging.« less

Authors:
; ; ; ; ; ;  [1];  [2];  [2];  [2]
  1. Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201 (United States)
  2. (United States)
Publication Date:
OSTI Identifier:
20726863
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 32; Journal Issue: 12; Other Information: DOI: 10.1118/1.2128089; (c) 2005 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ABDOMEN; AMPLITUDES; CARCINOMAS; COMPUTERIZED TOMOGRAPHY; ERRORS; EXHALATION; IMAGES; INHALATION; LUNGS; PATIENTS; PHANTOMS; PLANNING; RADIOTHERAPY; RESPIRATION

Citation Formats

D'Souza, Warren D., Kwok, Young, Deyoung, Chad, Zacharapoulos, Nicholas, Pepelea, Mark, Klahr, Paul, Yu, Cedric X., Aktina Inc., Congers, New York 10920, Philips Medical Systems, Cleveland, Ohio 44143, and Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201. Gated CT imaging using a free-breathing respiration signal from flow-volume spirometry. United States: N. p., 2005. Web. doi:10.1118/1.2128089.
D'Souza, Warren D., Kwok, Young, Deyoung, Chad, Zacharapoulos, Nicholas, Pepelea, Mark, Klahr, Paul, Yu, Cedric X., Aktina Inc., Congers, New York 10920, Philips Medical Systems, Cleveland, Ohio 44143, & Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201. Gated CT imaging using a free-breathing respiration signal from flow-volume spirometry. United States. doi:10.1118/1.2128089.
D'Souza, Warren D., Kwok, Young, Deyoung, Chad, Zacharapoulos, Nicholas, Pepelea, Mark, Klahr, Paul, Yu, Cedric X., Aktina Inc., Congers, New York 10920, Philips Medical Systems, Cleveland, Ohio 44143, and Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201. Thu . "Gated CT imaging using a free-breathing respiration signal from flow-volume spirometry". United States. doi:10.1118/1.2128089.
@article{osti_20726863,
title = {Gated CT imaging using a free-breathing respiration signal from flow-volume spirometry},
author = {D'Souza, Warren D. and Kwok, Young and Deyoung, Chad and Zacharapoulos, Nicholas and Pepelea, Mark and Klahr, Paul and Yu, Cedric X. and Aktina Inc., Congers, New York 10920 and Philips Medical Systems, Cleveland, Ohio 44143 and Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201},
abstractNote = {Respiration-induced tumor motion is known to cause artifacts on free-breathing spiral CT images used in treatment planning. This leads to inaccurate delineation of target volumes on planning CT images. Flow-volume spirometry has been used previously for breath-holds during CT scans and radiation treatments using the active breathing control (ABC) system. We have developed a prototype by extending the flow-volume spirometer device to obtain gated CT scans using a PQ 5000 single-slice CT scanner. To test our prototype, we designed motion phantoms to compare image quality obtained with and without gated CT scan acquisition. Spiral and axial (nongated and gated) CT scans were obtained of phantoms with motion periods of 3-5 s and amplitudes of 0.5-2 cm. Errors observed in the volume estimate of these structures were as much as 30% with moving phantoms during CT simulation. Application of motion-gated CT with active breathing control reduced these errors to within 5%. Motion-gated CT was then implemented in patients and the results are presented for two clinical cases: lung and abdomen. In each case, gated scans were acquired at end-inhalation, end-exhalation in addition to a conventional free-breathing (nongated) scan. The gated CT scans revealed reduced artifacts compared with the conventional free-breathing scan. Differences of up to 20% in the volume of the structures were observed between gated and free-breathing scans. A comparison of the overlap of structures between the gated and free-breathing scans revealed misalignment of the structures. These results demonstrate the ability of flow-volume spirometry to reduce errors in target volumes via gating during CT imaging.},
doi = {10.1118/1.2128089},
journal = {Medical Physics},
number = 12,
volume = 32,
place = {United States},
year = {Thu Dec 15 00:00:00 EST 2005},
month = {Thu Dec 15 00:00:00 EST 2005}
}
  • Purpose: Carbon nanotube (CNT) based field emission x-ray source technology has recently been investigated for diagnostic imaging applications because of its attractive characteristics including electronic programmability, fast switching, distributed source, and multiplexing. The purpose of this article is to demonstrate the potential of this technology for high-resolution prospective-gated cardiac micro-CT imaging. Methods: A dynamic cone-beam micro-CT scanner was constructed using a rotating gantry, a stationary mouse bed, a flat-panel detector, and a sealed CNT based microfocus x-ray source. The compact single-beam CNT x-ray source was operated at 50 KVp and 2 mA anode current with 100 {mu}mx100 {mu}m effective focalmore » spot size. Using an intravenously administered iodinated blood-pool contrast agent, prospective cardiac and respiratory-gated micro-CT images of beating mouse hearts were obtained from ten anesthetized free-breathing mice in their natural position. Four-dimensional cardiac images were also obtained by gating the image acquisition to different phases in the cardiac cycle. Results: High-resolution CT images of beating mouse hearts were obtained at 15 ms temporal resolution and 6.2 lp/mm spatial resolution at 10% of system MTF. The images were reconstructed at 76 {mu}m isotropic voxel size. The data acquisition time for two cardiac phases was 44{+-}9 min. The CT values observed within the ventricles and the ventricle wall were 455{+-}49 and 120{+-}48 HU, respectively. The entrance dose for the acquisition of a single phase of the cardiac cycle was 0.10 Gy. Conclusions: A high-resolution dynamic micro-CT scanner was developed from a compact CNT microfocus x-ray source and its feasibility for prospective-gated cardiac micro-CT imaging of free-breathing mice under their natural position was demonstrated.« less
  • Purpose: To assess and account for the impact of respiratory motion on the variability of activity and volume determination of liver tumor in positron emission tomography (PET) through a comparison between free-breathing (FB) and respiration-suspended (RS) PET images. Methods: As part of a PET/computed tomography (CT) guided percutaneous liver ablation procedure performed on a PET/CT scanner, a patient's breathing is suspended on a ventilator, allowing the acquisition of a near-motionless PET and CT reference images of the liver. In this study, baseline RS and FB PET/CT images of 20 patients undergoing thermal ablation were acquired. The RS PET provides near-motionlessmore » reference in a human study, and thereby allows a quantitative evaluation of the effect of respiratory motion on PET images obtained under FB conditions. Two methods were applied to calculate tumor activity and volume: (1) threshold-based segmentation (TBS), estimating the total lesion glycolysis (TLG) and the segmented volume and (2) histogram-based estimation (HBE), yielding the background-subtracted lesion (BSL) activity and associated volume. The TBS method employs 50% of the maximum standardized uptake value (SUV{sub max}) as the threshold for tumors with SUV{sub max} ≥ 2× SUV{sub liver-bkg}, and tumor activity above this threshold yields TLG{sub 50%}. The HBE method determines local PET background based on a Gaussian fit of the low SUV peak in a SUV-volume histogram, which is generated within a user-defined and optimized volume of interest containing both local background and lesion uptakes. Voxels with PET intensity above the fitted background were considered to have originated from the tumor and used to calculate the BSL activity and its associated lesion volume. Results: Respiratory motion caused SUV{sub max} to decrease from RS to FB by −15% ± 11% (p = 0.01). Using TBS method, there was also a decrease in SUV{sub mean} (−18% ± 9%, p = 0.01), but an increase in TLG{sub 50%} (18% ± 36%) and in the segmented volume (47% ± 52%, p = 0.01) from RS to FB PET images. The background uptake in normal liver was stable, 1% ± 9%. In contrast, using the HBE method, the differences in both BSL activity and BSL volume from RS to FB were −8% ± 10% (p = 0.005) and 0% ± 16% (p = 0.94), respectively. Conclusions: This is the first time that almost motion-free PET images of the human liver were acquired and compared to free-breathing PET. The BSL method's results are more consistent, for the calculation of both tumor activity and volume in RS and FB PET images, than those using conventional TBS. This suggests that the BSL method might be less sensitive to motion blurring and provides an improved estimation of tumor activity and volume in the presence of respiratory motion.« less
  • Purpose:Mouse models of cardiac diseases have proven to be a valuable tool in preclinical research. The high cardiac and respiratory rates of free breathing mice prohibit conventional in vivo cardiac perfusion studies using computed tomography even if gating methods are applied. This makes a sacrification of the animals unavoidable and only allows for the application of ex vivo methods. Methods: To overcome this issue the authors propose a low dose scan protocol and an associated reconstruction algorithm that allows for in vivo imaging of cardiac perfusion and associated processes that are retrospectively synchronized to the respiratory and cardiac motion ofmore » the animal. The scan protocol consists of repetitive injections of contrast media within several consecutive scans while the ECG, respiratory motion, and timestamp of contrast injection are recorded and synchronized to the acquired projections. The iterative reconstruction algorithm employs a six-dimensional edge-preserving filter to provide low-noise, motion artifact-free images of the animal examined using the authors' low dose scan protocol. Results: The reconstructions obtained show that the complete temporal bolus evolution can be visualized and quantified in any desired combination of cardiac and respiratory phase including reperfusion phases. The proposed reconstruction method thereby keeps the administered radiation dose at a minimum and thus reduces metabolic inference to the animal allowing for longitudinal studies. Conclusions: The authors' low dose scan protocol and phase-correlated dynamic reconstruction algorithm allow for an easy and effective way to visualize phase-correlated perfusion processes in routine laboratory studies using free-breathing mice.« less
  • Purpose: Despite the importance of accurately estimating the respiration regularity of a patient in motion compensation treatment, an effective and simply applicable method has rarely been reported. The authors propose a simple respiration regularity index based on parameters derived from a correspondingly simplified respiration model. Methods: In order to simplify a patient's breathing pattern while preserving the data's intrinsic properties, we defined a respiration model as a power of cosine form with a baseline drift. According to this respiration formula, breathing-pattern fluctuation could be explained using four factors: sample standard deviation of respiration period, sample standard deviation of amplitude andmore » the results of simple regression of the baseline drift (slope and standard deviation of residuals of a respiration signal. Overall irregularity (δ) was defined as a Euclidean norm of newly derived variable using principal component analysis (PCA) for the four fluctuation parameters. Finally, the proposed respiration regularity index was defined as ρ=ln(1+(1/ δ))/2, a higher ρ indicating a more regular breathing pattern. Subsequently, we applied it to simulated and clinical respiration signals from real-time position management (RPM; Varian Medical Systems, Palo Alto, CA) and investigated respiration regularity. Moreover, correlations between the regularity of the first session and the remaining fractions were investigated using Pearson's correlation coefficient. Results: The respiration regularity was determined based on ρ; patients with ρ<0.3 showed worse regularity than the others, whereas ρ>0.7 was suitable for respiratory-gated radiation therapy (RGRT). Fluctuations in breathing cycle and amplitude were especially determinative of ρ. If the respiration regularity of a patient's first session was known, it could be estimated through subsequent sessions. Conclusions: Respiration regularity could be objectively determined using a respiration regularity index, ρ. Such single-index testing of respiration regularity can facilitate determination of RGRT availability in clinical settings, especially for free-breathing cases. This work was supported by a Korea Science and Engineering Foundation (KOSEF) grant funded by the Korean Ministry of Science, ICT and Future Planning (No. 2013043498)« less
  • Purpose: Artifacts impacting the imaged tumor volume can be seen in conventional three-dimensional CT (3DCT) scans for planning of lung cancer radiotherapy but can be reduced with the use of respiration-correlated imaging, i.e., 4DCT or breathhold CT (BHCT) scans. The aim of this study was to compare delineated gross tumor volume (GTV) sizes in 3DCT, 4DCT, and BHCT scans of patients with lung tumors. Methods and Materials: A total of 36 patients with 46 tumors referred for stereotactic radiotherapy of lung tumors were included. All patients underwent positron emission tomography (PET)/CT, 4DCT, and BHCT scans. GTVs in all CT scansmore » of individual patients were delineated during one session by a single physician to minimize systematic delineation uncertainty. The GTV size from the BHCT was considered the closest to true tumor volume and was chosen as the reference. The reference GTV size was compared to GTV sizes in 3DCT, at midventilation (MidV), at end-inspiration (Insp), and at end-expiration (Exp) bins from the 4DCT scan. Results: The median BHCT GTV size was 4.9 cm{sup 3} (0.1-53.3 cm{sup 3}). Median deviation between 3DCT and BHCT GTV size was 0.3 cm{sup 3} (-3.3 to 30.0 cm{sup 3}), between MidV and BHCT size was 0.2 cm{sup 3} (-5.7 to 19.7 cm{sup 3}), between Insp and BHCT size was 0.3 cm{sup 3} (-4.7 to 24.8 cm{sup 3}), and between Exp and BHCT size was 0.3 cm{sup 3} (-4.8 to 25.5 cm{sup 3}). The 3DCT, MidV, Insp, and Exp median GTV sizes were all significantly larger than the BHCT median GTV size. Conclusions: In the present study, the choice of CT method significantly influenced the delineated GTV size, on average, leading to an increase in GTV size compared to the reference BHCT. The uncertainty caused by artifacts is estimated to be in the same magnitude as delineation uncertainty and should be considered in the design of margins for radiotherapy.« less