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Title: Phantom Study Investigating the Accuracy of Manual and Automatic Image Fusion with the GE Logiq E9: Implications for use in Percutaneous Liver Interventions

Abstract

PurposeTo determine the accuracy of automatic and manual co-registration methods for image fusion of three-dimensional computed tomography (CT) with real-time ultrasonography (US) for image-guided liver interventions.Materials and MethodsCT images of a skills phantom with liver lesions were acquired and co-registered to US using GE Logiq E9 navigation software. Manual co-registration was compared to automatic and semiautomatic co-registration using an active tracker. Also, manual point registration was compared to plane registration with and without an additional translation point. Finally, comparison was made between manual and automatic selection of reference points. In each experiment, accuracy of the co-registration method was determined by measurement of the residual displacement in phantom lesions by two independent observers.ResultsMean displacements for a superficial and deep liver lesion were comparable after manual and semiautomatic co-registration: 2.4 and 2.0 mm versus 2.0 and 2.5 mm, respectively. Both methods were significantly better than automatic co-registration: 5.9 and 5.2 mm residual displacement (p < 0.001; p < 0.01). The accuracy of manual point registration was higher than that of plane registration, the latter being heavily dependent on accurate matching of axial CT and US images by the operator. Automatic reference point selection resulted in significantly lower registration accuracy compared to manual point selection despite lower root-mean-square deviation (RMSD)more » values.ConclusionThe accuracy of manual and semiautomatic co-registration is better than that of automatic co-registration. For manual co-registration using a plane, choosing the correct plane orientation is an essential first step in the registration process. Automatic reference point selection based on RMSD values is error-prone.« less

Authors:
; ;  [1];  [2];  [3];  [2];  [1]
  1. Leiden University Medical Centre, Department of Radiology (Netherlands)
  2. Leiden University Medical Center, Interventional and Molecular Imaging Laboratory, Department of Radiology (Netherlands)
  3. Singapore General Hospital, Department of Interventional Radiology (Singapore)
Publication Date:
OSTI Identifier:
22645168
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 40; Journal Issue: 6; Other Information: Copyright (c) 2017 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Article Copyright (c) 2017 The Author(s); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ACCURACY; COMPARATIVE EVALUATIONS; COMPUTER CODES; COMPUTERIZED TOMOGRAPHY; ERRORS; IMAGES; LIVER; MANUALS; PHANTOMS; ULTRASONOGRAPHY

Citation Formats

Burgmans, Mark Christiaan, E-mail: m.c.burgmans@lumc.nl, Harder, J. Michiel den, E-mail: chiel.den.harder@gmail.com, Meershoek, Philippa, E-mail: P.Meershoek@lumc.nl, Berg, Nynke S. van den, E-mail: N.S.van-den-Berg@lumc.nl, Chan, Shaun Xavier Ju Min, E-mail: shaun.xavier.chan@singhealth.com.sg, Leeuwen, Fijs W. B. van, E-mail: F.W.B.van-Leeuwen@lumc.nl, and Erkel, Arian R. van, E-mail: a.r.van-erkel@lumc.nl. Phantom Study Investigating the Accuracy of Manual and Automatic Image Fusion with the GE Logiq E9: Implications for use in Percutaneous Liver Interventions. United States: N. p., 2017. Web. doi:10.1007/S00270-017-1607-3.
Burgmans, Mark Christiaan, E-mail: m.c.burgmans@lumc.nl, Harder, J. Michiel den, E-mail: chiel.den.harder@gmail.com, Meershoek, Philippa, E-mail: P.Meershoek@lumc.nl, Berg, Nynke S. van den, E-mail: N.S.van-den-Berg@lumc.nl, Chan, Shaun Xavier Ju Min, E-mail: shaun.xavier.chan@singhealth.com.sg, Leeuwen, Fijs W. B. van, E-mail: F.W.B.van-Leeuwen@lumc.nl, & Erkel, Arian R. van, E-mail: a.r.van-erkel@lumc.nl. Phantom Study Investigating the Accuracy of Manual and Automatic Image Fusion with the GE Logiq E9: Implications for use in Percutaneous Liver Interventions. United States. doi:10.1007/S00270-017-1607-3.
Burgmans, Mark Christiaan, E-mail: m.c.burgmans@lumc.nl, Harder, J. Michiel den, E-mail: chiel.den.harder@gmail.com, Meershoek, Philippa, E-mail: P.Meershoek@lumc.nl, Berg, Nynke S. van den, E-mail: N.S.van-den-Berg@lumc.nl, Chan, Shaun Xavier Ju Min, E-mail: shaun.xavier.chan@singhealth.com.sg, Leeuwen, Fijs W. B. van, E-mail: F.W.B.van-Leeuwen@lumc.nl, and Erkel, Arian R. van, E-mail: a.r.van-erkel@lumc.nl. Thu . "Phantom Study Investigating the Accuracy of Manual and Automatic Image Fusion with the GE Logiq E9: Implications for use in Percutaneous Liver Interventions". United States. doi:10.1007/S00270-017-1607-3.
@article{osti_22645168,
title = {Phantom Study Investigating the Accuracy of Manual and Automatic Image Fusion with the GE Logiq E9: Implications for use in Percutaneous Liver Interventions},
author = {Burgmans, Mark Christiaan, E-mail: m.c.burgmans@lumc.nl and Harder, J. Michiel den, E-mail: chiel.den.harder@gmail.com and Meershoek, Philippa, E-mail: P.Meershoek@lumc.nl and Berg, Nynke S. van den, E-mail: N.S.van-den-Berg@lumc.nl and Chan, Shaun Xavier Ju Min, E-mail: shaun.xavier.chan@singhealth.com.sg and Leeuwen, Fijs W. B. van, E-mail: F.W.B.van-Leeuwen@lumc.nl and Erkel, Arian R. van, E-mail: a.r.van-erkel@lumc.nl},
abstractNote = {PurposeTo determine the accuracy of automatic and manual co-registration methods for image fusion of three-dimensional computed tomography (CT) with real-time ultrasonography (US) for image-guided liver interventions.Materials and MethodsCT images of a skills phantom with liver lesions were acquired and co-registered to US using GE Logiq E9 navigation software. Manual co-registration was compared to automatic and semiautomatic co-registration using an active tracker. Also, manual point registration was compared to plane registration with and without an additional translation point. Finally, comparison was made between manual and automatic selection of reference points. In each experiment, accuracy of the co-registration method was determined by measurement of the residual displacement in phantom lesions by two independent observers.ResultsMean displacements for a superficial and deep liver lesion were comparable after manual and semiautomatic co-registration: 2.4 and 2.0 mm versus 2.0 and 2.5 mm, respectively. Both methods were significantly better than automatic co-registration: 5.9 and 5.2 mm residual displacement (p < 0.001; p < 0.01). The accuracy of manual point registration was higher than that of plane registration, the latter being heavily dependent on accurate matching of axial CT and US images by the operator. Automatic reference point selection resulted in significantly lower registration accuracy compared to manual point selection despite lower root-mean-square deviation (RMSD) values.ConclusionThe accuracy of manual and semiautomatic co-registration is better than that of automatic co-registration. For manual co-registration using a plane, choosing the correct plane orientation is an essential first step in the registration process. Automatic reference point selection based on RMSD values is error-prone.},
doi = {10.1007/S00270-017-1607-3},
journal = {Cardiovascular and Interventional Radiology},
number = 6,
volume = 40,
place = {United States},
year = {Thu Jun 15 00:00:00 EDT 2017},
month = {Thu Jun 15 00:00:00 EDT 2017}
}
  • Purpose: To evaluate the positioning accuracies of two image-guided localization systems, ExacTrac and On-Board Imager (OBI), in a stereotactic treatment unit. Methods and Materials: An anthropomorphic pelvis phantom with eight internal metal markers (BBs) was used. The center of one BB was set as plan isocenter. The phantom was set up on a treatment table with various initial setup errors. Then, the errors were corrected using each of the investigated systems. The residual errors were measured with respect to the radiation isocenter using orthogonal portal images with field size 3 x 3 cm{sup 2}. The angular localization discrepancies of themore » two systems and the correction accuracy of the robotic couch were also studied. A pair of pre- and post-cone beam computed tomography (CBCT) images was acquired for each angular correction. Then, the correction errors were estimated by using the internal BBs through fiducial marker-based registrations. Results: The isocenter localization errors ({mu} {+-}{sigma}) in the left/right, posterior/anterior, and superior/inferior directions were, respectively, -0.2 {+-} 0.2 mm, -0.8 {+-} 0.2 mm, and -0.8 {+-} 0.4 mm for ExacTrac, and 0.5 {+-} 0.7 mm, 0.6 {+-} 0.5 mm, and 0.0 {+-} 0.5 mm for OBI CBCT. The registration angular discrepancy was 0.1 {+-} 0.2{sup o} between the two systems, and the maximum angle correction error of the robotic couch was 0.2{sup o} about all axes. Conclusion: Both the ExacTrac and the OBI CBCT systems showed approximately 1 mm isocenter localization accuracies. The angular discrepancy of two systems was minimal, and the robotic couch angle correction was accurate. These positioning uncertainties should be taken as a lower bound because the results were based on a rigid dosimetry phantom.« less
  • Purpose: SymmetryTM 4D IGRT system of Elekta has been installed at our institution, which offers the 4D CBCT registration option. This study is to evaluate the accuracy of 4D CBCT system by using the CIRS 4D motion phantom and to perform a feasibility study on the implementation of 4D-CBCT as image guidance for SBRT treatment. Methods: The 3D and 4D CT image data sets are acquired using the CIRS motion phantom on a Philips large bore CT simulator. The motion was set as 0.5 cm superior and inferior directions with 6 seconds recycle time. The 4D CT data were sortedmore » as 10 phases. One identifiable part of the 4D CT QA insert from CIRS phantom was used as the target. The ITV MIP was drawn based on maximum intensity projection (MIP) and transferred as a planning structure into 4D CBCT system. Then the 3D CBCT and 4D CBCT images were taken and registered with the free breath (3D), MIP (4D) and average intensity projection (AIP)(4D) reference data sets. The couch shifts (X, Y, Z) are recorded and compared. Results: Table 1 listed the twelve couch shifts based on the registration of MIP, AIP and free breath CT data sets with 3D CBCT and 4D CBCT for both whole body and local registration. X, Y and Z represent couch shifts in the direction of the right-left, superior-inferior and anterior-posterior. The biggest differences of 0.73 cm and 0.57 cm are noted in the free breath CT data with 4D CBCT and 3D CBCT data registration. Fig. 1 and Fig. 2 are the shift analysis in diagram. Fig. 3 shows the registration. Conclusion: Significant differences exist in the shifts corresponding with the direction of target motion. Further investigations are ongoing.« less
  • Purpose: To compare and quantify respiratory motion artifacts in images from free breathing 4D-CT-on-Rails(CTOR) and those from MV-Cone-beam-CT(MVCB) and facilitate respiratory motion guided radiation therapy. Methods: 4D-CTOR: Siemens Somatom CT-on-Rails system with Anzai belt loaded with pressure sensor load cells. 4D scans were performed in helical mode, pitch 0.1, gantry rotation time 0.5s, 1.5mm slice thickness, 120kVp, 400 mAs. Normal and fast breathing (>12rpm) scanning protocols were investigated. Helical scan, AIP(average intensity projection) and MIP(maximum intensity projection) were generated from 4D-CTOR scans with amplitude sorting into 10 phases.MVCB: Siemens Artiste diamond view(1MV)MVCB was performed with 5MU thorax protocol with 60more » second of full rotation.Phantom: Anzai AZ-733V respiratory phantom. The settings were set to normal and resp. modes with repetition rates at 15 rpm and 10 rpm. Surgical clips, acrylic, wooden, rubber and lung density, total six mock-ups were scanned and compared in this study.Signal-to-noise ratio(SNR), contrast-to-noise ratio(CNR) and reconstructed motion volume were compared to different respiratory setups for the mock-ups. Results: Reconstructed motion volume was compared to the real object volume for the six test mock-ups. It shows that free breathing helical in all instances underestimates the object excursions largest to −67.4% and least −6.3%. Under normal breathing settings, MIP can predict very precise motion volume with minimum 0.4% and largest −13.9%. MVCB shows underestimate of the motion volume with −1.11% minimum and −18.0% maximum. With fast breathing, AIP provides bad representation of the object motion; however, the MIP can predict the motion volume with −2.0% to −11.4% underestimate. Conclusion: Respiratory motion guided radiation therapy requires good motion recording. This study shows that regular CTOR helical scans provides bad guidance, 4D CTOR AIP cannot represent the fast breathing pattern, MIP can represent the best motion volume, MVCBCT can only be used for normal breathing with acceptable uncertainties.« less
  • The aim of this study was to assess the potential of a modern x,y,z modulation-based automatic exposure control system (AEC) for dose reduction in pediatric and adult multidetector CT (MDCT) imaging and evaluate the quality of the images obtained. Five physical anthropomorphic phantoms that simulate the average individual as neonate, 1-, 5-, 10-year old child, and adult were scanned with a MDCT scanner, equipped with a modern AEC system. Dose reduction (%DR) was calculated as the percentage difference of the mean modulated and the preset tube current-time product that is prescribed for standard head and body scan protocols. The effectmore » of the tube potential and the orientation of the topogram acquisition on dose reduction were assessed. Image quality was evaluated on the basis of image noise and signal to noise ratio (SNR). The dose reduction values achieved in pediatric phantoms were remarkably lower than those achieved for the adult. The efficiency of the AEC is decreased at 80 kVp compared to higher tube potentials and for helical scans following an anterior posterior (AP-AEC) compared to a lateral (LAT-AEC) topogram acquisition. In AP-AEC scans, the dose reduction ranged between 4.7 and 34.7% for neonate, 15.4 and 30.9% for 1 year old, 3.1 and 26.7% for 5 years old, 1.2 and 58.7% for 10 years old, and 15.5 and 57.4% for adult. In LAT-AEC scans, the corresponding dose reduction ranged between 11.0 and 36.5%, 27.2 and 35.7%, 11.3 and 35.6%, 0.3 and 67.0%, and 15.0 and 61.7%, respectively. AP-AEC scans resulted in a 17.1% and 19.7% dose increase in the thorax of neonate and the pelvis of the 10-year old phantom, respectively. The variation in the measured noise among images obtained along the scanning z axis was lower in AEC activated compared to fixed milliamperes scans. However, image noise was significantly increased (P<.001) and SNR significantly decreased (P<.001) in most AEC activated compared to fixed milliamperes scans. In conclusion, AEC resulted in a (i) substantial dose reduction, which is less pronounced in children compared to adult, (ii) higher dose reduction in scans following a lateral compared to scans following an anterior-posterior topogram acquisition, (iii) increase of image noise and degradation of SNR in the obtained images compared to the fixed milliamperes technique.« less
  • Purpose: To investigate the benefits and limitations of patient-phantom matching for determining organ dose during fluoroscopy guided interventions. Methods: In this study, 27 CT datasets representing patients of different sizes and genders were contoured and converted into patient-specific computational models. Each model was matched, based on height and weight, to computational phantoms selected from the UF hybrid patient-dependent series. In order to investigate the influence of phantom type on patient organ dose, Monte Carlo methods were used to simulate two cardiac projections (PA/left lateral) and two abdominal projections (RAO/LPO). Organ dose conversion coefficients were then calculated for each patient-specific andmore » patient-dependent phantom and also for a reference stylized and reference hybrid phantom. The coefficients were subsequently analyzed for any correlation between patient-specificity and the accuracy of the dose estimate. Accuracy was quantified by calculating an absolute percent difference using the patient-specific dose conversion coefficients as the reference. Results: Patient-phantom matching was shown most beneficial for estimating the dose to heavy patients. In these cases, the improvement over using a reference stylized phantom ranged from approximately 50% to 120% for abdominal projections and for a reference hybrid phantom from 20% to 60% for all projections. For lighter individuals, patient-phantom matching was clearly superior to using a reference stylized phantom, but not significantly better than using a reference hybrid phantom for certain fields and projections. Conclusions: The results indicate two sources of error when patients are matched with phantoms: Anatomical error, which is inherent due to differences in organ size and location, and error attributed to differences in the total soft tissue attenuation. For small patients, differences in soft tissue attenuation are minimal and are exceeded by inherent anatomical differences. For large patients, difference in soft tissue attenuation can be large. In these cases, patient-phantom matching proves most effective as differences in soft tissue attenuation are mitigated. With increasing obesity rates, overweight patients will continue to make up a growing fraction of all patients undergoing medical imaging. Thus, having phantoms that better represent this population represents a considerable improvement over previous methods. In response to this study, additional phantoms representing heavier weight percentiles will be added to the UFHADM and UFHADF patient-dependent series.« less