Hsieh, Scott S.

AbstractPurposeMobile lung tumors are increasingly being treated with ablative radiotherapy, for which precise motion management is essential. In‐room stereoscopic radiography systems are able to guide ablative radiotherapy for stationary cranial lesions but not optimally for lung tumors unless fiducial markers are inserted. We propose augmenting stereoscopic radiographic systems with multiple small x‐ray sources to provide the capability of imaging with stereoscopic, single frame tomosynthesis.MethodsIn single frame tomosynthesis, nine x‐ray sources are placed in a 3 × 3 configuration and energized simultaneously. The beams from these sources are collimated so that they converge on the tumor and then diverge to illuminate nine non‐overlapping sectors on the detector. These nine sector images are averaged together and filtered to create the tomosynthesis effect. Single frame tomosynthesis is intended to be an alternative imaging mode for existing stereoscopic systems with a field of view that is three times smaller and a temporal resolution equal to the frame rate of the detector. We simulated stereoscopic tomosynthesis and radiography using Monte Carlo techniques on 60 patients with early‐stage lung cancer from the NSCLC‐Radiomics dataset. Two board‐certified radiation oncologists reviewed these simulated images and rated them on a 4‐point scale (1: tumor not visible; 2: tumor visible but inadequate for motion management; 3: tumor visible and adequate for motion management; 4: tumor visibility excellent). Each tumor was independently presented four times (two viewing angles from radiography and two viewing angles from tomosynthesis) in a blinded fashion over two reading sessions.ResultsThe fraction of tumors that were rated as adequate or excellent for motion management (scores 3 or 4) from at least one viewing angle was 53% using radiography and 90% using tomosynthesis. From both viewing angles, the corresponding fractions were 7% for radiography and 48% for tomosynthesis. Readers agreed exactly on 62% of images and within 1 point on 98% of images. The acquisition technique was estimated to be 75 mAs at 120 kVp per treatment fraction assuming one verification image per breath, approximately one order of magnitude less than a standard dose cone beam CT.Conclusions Stereoscopic tomosynthesis may provide a noninvasive, low dose, intrafraction motion verification technique for lung tumors treated by ablative radiotherapy. The system architecture is compatible with real‐time video capture at 30 frames per second. Simulations suggest that most, but not all, lung tumors can be adequately visualized from at least one viewing angle.

AbstractPurposeCharge sharing is a major non‐ideality in photon counting detectors (PCDs) and can increase variance in material decomposition images. Analog charge summing (ACS) is an effective mechanism for charge sharing compensation (CSC), but is complex to implement and may limit the maximum count rate of the PCD. Digital CSC mechanisms such as digital count summing (DCS) may be simpler to implement; however, earlier simulation studies suggest that digital CSC only provides half the benefit of ACS. We propose including an additional low‐threshold comparator (LTC) underneath the noise floor of the PCD to improve the effectiveness of digital CSC.MethodsWe simulated a PCD with four or eight equally spaced energy bins. X‐ray photons arrived on the PCD following a Poisson distribution, and charge was allocated to PCD pixels following Monte Carlo techniques. Gaussian electronic noise was added with standard deviation of 2 keV and the signals were processed with four CSC schemes: no CSC, ACS, DCS, and DCS with LTC. The energy bins were placed from 25 to 100 keV at 25 keV intervals (for four bins) or from 25 to 112.5 keV at 12.5 keV intervals (for eight bins), and the LTC threshold was placed at 8 keV in both cases. The binned counts were transformed into estimates of water and iodine material thickness using a linear estimator that was fitted to the data. Our simulations were performed in the low‐flux limit without any pileup, assuming a 120 kVp spectrum, 25 cm water object, and 0.3 mm PCD pixel size.ResultsAll CSC schemes decreased variance in basis material decomposition. In the four‐bin PCD, the relative dose efficiencies (inverse of the variance) for iodine material decomposition were 1.0, 2.4, 3.2, and 4.3 for a PCD without CSC, DCS without LTC, DCS with LTC, and ACS, respectively. In the eight‐bin PCD, the relative dose efficiencies were 1.1, 2.5, 3.1, and 4.8, respectively. In a sensitivity analysis, electronic noise had a stronger deleterious effect on ACS than DCS. In simulated visual images, DCS and ACS improved high frequency contrast in material decomposition images.ConclusionsIntroducing an LTC may reduce the performance differential between DCS and ACS. These findings have been derived from simulation studies only and have not been validated experimentally.

PurposeLow contrast detectability (LCD) is a metric of fundamental importance in computed tomography (CT) imaging. In spite of this, its measurement is challenging in the context of nonlinear data processing. We introduce a new framework for objectively characterizing LCD with a single scan of a special‐purpose phantom and automated analysis software. The output of the analysis software is a “machine LCD” metric which is more representative of LCD than contrast‐noise ratio (CNR). It is not intended to replace human observer or model observer studies.MethodsFollowing preliminary simulations, we fabricated a phantom containing hundreds of low‐contrast beads. These beads are acrylic spheres (1.6 mm, net contrast ~10 HU) suspended and randomly dispersed in a background matrix of nylon pellets and isoattenuating saline. The task was to search for and localize the beads. A modified matched filter was used to automatically scan the reconstruction and select candidate bead localizations of varying confidence. These were compared to bead locations as determined from a high‐dose reference scan to produce free‐response ROC curves. We compared iterative reconstruction (IR) and filtered backpropagation (FBP) at multiple dose levels between 40 and 240 mAs. The scans at 60, 120, and 180 mAs were performed three times each to estimate uncertainty.ResultsExperimental scans demonstrated the feasibility of our technique. Our metric for machine LCD was the area under the exponential transform of the FROC curve (AUC). AUC increased monotonically from 0.21 at 40 mAs to 0.84 at 240 mAs. The sample standard deviation of AUC was approximately 0.02. This measurement uncertainty in AUC corresponded to a change in tube current of 4% to 8%. Surprisingly, we found that AUCs for IR were slightly worse than AUCs for FBP. While the phantom was sufficient for these experiments, it contained small air bubbles and alternative fabrication methods will be necessary for widespread utilization.ConclusionsIt is feasible to measure machine LCD using a search task on a phantom with hundreds of beads and to obtain tight error bars using only a single scan. Our method could facilitate routine quality assurance or possibly enable comparisons between different protocols and scanners.

PurposeFluoroscopy has been a tool of choice for monitoring treatments or interventions because of its extremely fast imaging times. However, the contrast obtained in fluoroscopy may be insufficient for certain clinical applications. In stereotactic ablative radiation therapy of the lung, fluoroscopy often lacks sufficient contrast for gating treatment. The purpose of this work is to describe and assess a real‐time tomosynthesis design that can produce sufficient contrast for guidance of lung tumor treatment within a small field of view.MethodsPrevious tomosynthesis designs in radiation oncology have temporal resolution on the order of seconds. The proposed system design uses parallel acquisition of multiple frames by simultaneously illuminating the field of view with multiple sources, enabling a temporal resolution of up to 30 frames per second. For a small field of view, a single flat‐panel detector could be used if different sectors of the detector are assigned to specific sources. Simulated images were generated by forward projection of existing clinical datasets. The authors varied the number of tubes and the power of each tube in order to determine the impact on tumor visualization.ResultsVisualization of the tumor was much clearer in tomosynthesis than in fluoroscopy. Contrast generally improved with the number of sources used, and a minimum of four sources should be used. The high contrast of the lung allows very low system power, and in most cases, less than 1 mA was needed. More power is required in the lateral direction than the AP direction.ConclusionsThe proposed system produces images adequate for real‐time guidance of radiation therapy. The additional hardware requirements are modest, and the system is capable of imaging at high frame rates and low dose. Further development, including a prototype system and a dosimetry study, is needed to further evaluate the feasibility of this device for radiation therapy guidance.