Respiratory signal estimation for cardiac perfusion SPECT using deep learning

BACKGROUND

Respiratory motion induces artifacts in reconstructed cardiac perfusion SPECT images. Correction for respiratory motion often relies on a respiratory signal describing the heart displacements during breathing. However, using external tracking devices to estimate respiratory signals can add cost and operational complications in a clinical setting.

PURPOSE

We aim to develop a deep learning (DL) approach that uses only SPECT projection data for respiratory signal estimation.

METHODS

A modified U-Net was implemented that takes temporally finely sampled SPECT sub-projection data (100 ms) as input. These sub-projections are obtained by reframing the 20-s list-mode data, resulting in 200 sub-projections, at each projection angle for each SPECT camera head. The network outputs a 200-time-point motion signal for each projection angle, which was later aggregated over all angles to give a full respiratory signal. The target signal for DL model training was from an external stereo-camera visual tracking system (VTS). In addition to comparing DL and VTS, we also included a data-driven approach based on the center-of-mass (CoM) strategy. This CoM method estimates respiratory signals by monitoring the axial changes of CoM for counts in the heart region of the sub-projections. We utilized 900 subjects with stress cardiac perfusion SPECT studies, with 302 subjects for testing and the remaining 598 subjects for training and validation.

RESULTS

The Pearson's correlation coefficient between the DL respiratory signal and the reference VTS signal was 0.90, compared to 0.70 between the CoM signal and the reference. For respiratory motion correction on SPECT images, all VTS, DL, and CoM approaches partially de-blured the heart wall, resulting in a thinner wall thickness and increased recovered maximal image intensity within the wall, with VTS reducing blurring the most followed by the DL approach. Uptake quantification for the combined anterior and inferior segments of polar maps showed a mean absolute difference from the reference VTS of 1.7% for the DL method for patients with motion >12 mm, compared to 2.6% for the CoM method and 8.5% for no correction.

CONCLUSION

We demonstrate the capability of a DL approach to estimate respiratory signal from SPECT projection data for cardiac perfusion imaging. Our results show that the DL based respiratory motion correction reduces artefacts and achieves similar regional quantification to that obtained using the stereo-camera VTS signals. This may enable fully automatic data-driven respiratory motion correction without relying on external motion tracking devices.

Observer studies of image quality of denoising reduced-count cardiac single photon emission computed tomography myocardial perfusion imaging by three-dimensional Gaussian post-reconstruction filtering and deep learning

BACKGROUND

The aim of this research was to asses perfusion-defect detection-accuracy by human observers as a function of reduced-counts for 3D Gaussian post-reconstruction filtering vs deep learning (DL) denoising to determine if there was improved performance with DL.

METHODS

SPECT projection data of 156 normally interpreted patients were used for these studies. Half were altered to include hybrid perfusion defects with defect presence and location known. Ordered-subset expectation-maximization (OSEM) reconstruction was employed with the optional correction of attenuation (AC) and scatter (SC) in addition to distance-dependent resolution (RC). Count levels varied from full-counts (100%) to 6.25% of full-counts. The denoising strategies were previously optimized for defect detection using total perfusion deficit (TPD). Four medical physicist (PhD) and six physician (MD) observers rated the slices using a graphical user interface. Observer ratings were analyzed using the LABMRMC multi-reader, multi-case receiver-operating-characteristic (ROC) software to calculate and compare statistically the area-under-the-ROC-curves (AUCs).

RESULTS

For the same count-level no statistically significant increase in AUCs for DL over Gaussian denoising was determined when counts were reduced to either the 25% or 12.5% of full-counts. The average AUC for full-count OSEM with solely RC and Gaussian filtering was lower than for the strategies with AC and SC, except for a reduction to 6.25% of full-counts, thus verifying the utility of employing AC and SC with RC.

CONCLUSION

We did not find any indication that at the dose levels investigated and with the DL network employed, that DL denoising was superior in AUC to optimized 3D post-reconstruction Gaussian filtering.

Optimal initial position and technique for the front foot contact phase of cricket fast bowling: Commonalities between individual-specific simulations of elite bowlers

Group-based and individual-based studies in cricket fast bowling have identified common technique characteristics associated with ball release speed. The applicability of these findings to individual bowlers is often questioned, however, due to research approach limitations. This study aims to identify whether the optimal initial body position at front foot contact and subsequent technique to maximise ball release speed exhibit common characteristics for elite male cricket fast bowlers using individual-specific computer optimisations. A planar 16-segment whole-body torque-driven simulation model of the front foot contact phase of fast bowling was customised, evaluated, and the initial body position and subsequent movement pattern optimised, for ten elite male fast bowlers. The optimised techniques significantly increased ball release speed by 4.8 ± 1.3 ms-1 (13.5 ± 4.1%) and ranged between 37.8 and 42.9 ms-1, and in lower peak ground reaction forces and loading rates. Common characteristics were observed within the optimal initial body position with more extended front knees, as well as more flexion of the front and bowling arm shoulders than in current performances. Delays to the onset of trunk flexion, front arm and bowling arm shoulder extension, and wrist flexion were also common in the subsequent movement during the front foot contact phase. Lower front hip extensor and front shoulder flexor torques, as well as greater bowling shoulder extensor torques were also evident. This is useful knowledge for coach development, talent identification, and coaching practice.

Effects of racket moment of inertia on racket head speed, impact location and shuttlecock speed during the badminton smash

How the racket properties impact performance of the badminton smash is relatively unknown, and further insight could help players/coaches select the most appropriate racket. Three-dimensional position data of the racket and shuttlecock were collected (500 Hz) for 20 experienced badminton players performing a series of forehand smashes with five swingweight ([Formula: see text]) perturbed rackets, ranging from 85-106 kg·cm2. [Formula: see text] was calculated using a balance board and simple pendulum method, and modal analysis was performed using laser vibrometry to capture the fundamental frequency and distal node location for each racket. As [Formula: see text] increased a reduction in racket head speed was found with on average a 0.7 m·s-1 decrease per 5 kg·cm2 increase in [Formula: see text], however this did not lead to slower shuttlecock speeds. The impact location tended to move closer to the tip as the fundamental frequency node moved closer to the tip (as [Formula: see text] increased), providing some evidence that participants may subconsciously strike the shuttlecock at the node location to provide desirable sensory feedback. The increase in racket head speed but not shuttlecock speed was likely due to the distal increase in longitudinal impact location as [Formula: see text] increased, as well as an increase in effective mass for a given impact location. Additionally, removal of the deformation component (additional racket head speed due to the racket noticeably bending and recovering) of racket head speed increased the effect size of the relationship with [Formula: see text], where rackets with greater [Formula: see text] had larger deformation velocities. The research provides further insight into the smash performance characteristics of experienced badminton players, particularly based on racket properties. Further research is required to confirm the coincidence between node location and longitudinal impact location.

Cricket fast bowling: The relationship between range of motion and key performance and injury technique characteristics

Fast bowling technique characteristics associated with performance and injury have been established; however, the effect of joint range of motion (ROM) on technique remains unknown. This study aimed to investigate ROM and its effect on fast bowling technique. Eighteen ROM measures and thirteen technique parameters were determined for 45 elite male fast bowlers. Twenty-three significant correlations were found between the shoulder, hip, and ankle ROM measures and technique parameters (r = 0.300-0.452; p < 0.05). Shoulder ROM was observed to have the highest number of correlations with fast bowling technique. Increased internal rotation, less external rotation, and greater total arc of rotation were associated with technique characteristics previously linked with increased ball release speed and decreased lumbar stress injury risk. Although hip and ankle ROM were also correlated with technique, their association is yet to be understood. Future research should aim to determine the impact of ROM on fast bowling movement patterns. This knowledge is likely to be useful in enhancing the coaching and rehabilitation of fast bowlers from lumbar stress injuries.

Mesh modeling of system geometry and anatomy phantoms for realistic GATE simulations and their inclusion in SPECT reconstruction

Objective.Monte-Carlo simulation studies have been essential for advancing various developments in single photon emission computed tomography (SPECT) imaging, such as system design and accurate image reconstruction. Among the simulation software available, Geant4 application for tomographic emission (GATE) is one of the most used simulation toolkits in nuclear medicine, which allows building systems and attenuation phantom geometries based on the combination of idealized volumes. However, these idealized volumes are inadequate for modeling free-form shape components of such geometries. Recent GATE versions alleviate these major limitations by allowing users to import triangulated surface meshes.Approach.In this study, we describe our mesh-based simulations of a next-generation multi-pinhole SPECT system dedicated to clinical brain imaging, called AdaptiSPECT-C. To simulate realistic imaging data, we incorporated in our simulation the XCAT phantom, which provides an advanced anatomical description of the human body. An additional challenge with the AdaptiSPECT-C geometry is that the default voxelized XCAT attenuation phantom was not usable in our simulation due to intersection of objects of dissimilar materials caused by overlap of the air containing regions of the XCAT beyond the surface of the phantom and the components of the imaging system.Main results.We validated our mesh-based modeling against the one constructed by idealized volumes for a simplified single vertex configuration of AdaptiSPECT-C through simulated projection data of123I-activity distributions. We resolved the overlap conflict by creating and incorporating a mesh-based attenuation phantom following a volume hierarchy. We then evaluated our reconstructions with attenuation and scatter correction for projections obtained from simulation consisting of mesh-based modeling of the system and the attenuation phantom for brain imaging. Our approach demonstrated similar performance as the reference scheme simulated in air for uniform and clinical-like123I-IMP brain perfusion source distributions.Significance.This work enables the simulation of complex SPECT acquisitions and reconstructions for emulating realistic imaging data close to those of actual patients.

Cross-vender, cross-tracer, and cross-protocol deep transfer learning for attenuation map generation of cardiac SPECT

It has been proved feasible to generate attenuation maps (μ-maps) from cardiac SPECT using deep learning. However, this assumed that the training and testing datasets were acquired using the same scanner, tracer, and protocol. We investigated a robust generation of CT-derived μ-maps from cardiac SPECT acquired by different scanners, tracers, and protocols from the training data. We first pre-trained a network using 120 studies injected with 99mTc-tetrofosmin acquired from a GE 850 SPECT/CT with 360-degree gantry rotation, which was then fine-tuned and tested using 80 studies injected with 99mTc-sestamibi acquired from a Philips BrightView SPECT/CT with 180-degree gantry rotation. The error between ground-truth and predicted μ-maps by transfer learning was 5.13 ± 7.02%, as compared to 8.24 ± 5.01% by direct transition without fine-tuning and 6.45 ± 5.75% by limited-sample training. The error between ground-truth and reconstructed images with predicted μ-maps by transfer learning was 1.11 ± 1.57%, as compared to 1.72 ± 1.63% by direct transition and 1.68 ± 1.21% by limited-sample training. It is feasible to apply a network pre-trained by a large amount of data from one scanner to data acquired by another scanner using different tracers and protocols, with proper transfer learning.

A rapid in vitro assay for evaluating the effects of acetylcholinesterase inhibitors and reactivators in the rat basolateral amygdala

We established a novel brain slice assay to test the ability of acetylcholinesterase (AChE) reactivators to prevent ACh-induced M1 muscarinic acetylcholine receptor (mAChR) dependent hyperexcitability observed after exposure to the organophosphate (OP)-based AChE inhibitor and sarin surrogate 4-nitrophenyl isopropyl methylphosphonate (NIMP). Whole-cell patch clamp recordings were used to evaluate the response of pyramidal neurons in the rat basolateral amygdala (BLA) to brief (1 min) bath application of ACh (100 μM), either in control conditions, or after exposure to NIMP ± an AChE reactivator. Bath application of ACh produced atropine- and pirenzepine-sensitive inward currents in voltage clamped BLA pyramidal neurons, and increased the frequency of spontaneous EPSCs, suggesting robust activation of M1 mAChRs. Responses to ACh were increased ~3–5 fold in slices that had been preincubated in NIMP, and these effects were reversed in a concentration dependent manner by exposure to a commercially available AChE reactivator. The current work outlines a simple assay that can be used to evaluate the efficacy of both known and novel AChE reactivators in an area of the limbic system that likely contributes to seizures after acute exposure to OP-based AChE inhibitors.

Improving detection accuracy of perfusion defect in standard dose SPECT-myocardial perfusion imaging by deep-learning denoising

BACKGROUND

We previously developed a deep-learning (DL) network for image denoising in SPECT-myocardial perfusion imaging (MPI). Here we investigate whether this DL network can be utilized for improving detection of perfusion defects in standard-dose clinical acquisitions.

METHODS

To quantify perfusion-defect detection accuracy, we conducted a receiver-operating characteristic (ROC) analysis on reconstructed images with and without processing by the DL network using a set of clinical SPECT-MPI data from 190 subjects. For perfusion-defect detection hybrid studies were used as ground truth, which were created from clinically normal studies with simulated realistic lesions inserted. We considered ordered-subset expectation-maximization (OSEM) reconstruction with corrections for attenuation, resolution, and scatter and with 3D Gaussian post-filtering. Total perfusion deficit (TPD) scores, computed by Quantitative Perfusion SPECT (QPS) software, were used to evaluate the reconstructed images.

RESULTS

Compared to reconstruction with optimal Gaussian post-filtering (sigma = 1.2 voxels), further DL denoising increased the area under the ROC curve (AUC) from 0.80 to 0.88 (P-value < 10-4). For reconstruction with less Gaussian post-filtering (sigma = 0.8 voxels), thus better spatial resolution, DL denoising increased the AUC value from 0.78 to 0.86 (P-value < 10-4) and achieved better spatial resolution in reconstruction.

CONCLUSIONS

DL denoising can effectively improve the detection of abnormal defects in standard-dose SPECT-MPI images over conventional reconstruction.

Data-driven respiratory signal estimation from temporally finely sampled projection data in conventional cardiac perfusion SPECT imaging

PURPOSE

The aim of this work was to revisit the data-driven approach of axial center-of-mass (COM) measurements to recover a surrogate respiratory signal from finely sampled (100 ms) single photon emission computed tomography (SPECT) projection data derived from list-mode acquisitions.

METHODS

For our initial evaluation, we acquired list-mode projection data from an anthropomorphic cardiac phantom mounted on a Quasar respiratory motion platform simulating 15 mm amplitude respiratory motion. We also selected 302 consecutive patients (138 males, 164 females) with list-mode acquisitions, external respiratory motion tracking, and written consent to evaluate the clinical efficacy of our data-driven approach. Linear regression, Pearson's correlation coefficient (r), and standard error of the estimates (SEE) between the respiratory signals obtained with a visual tracking system (VTS) and COM measurements were calculated for individual projection data sets and for the patient group as a whole. Both the VTS- and COM-derived respiratory signals were used to estimate and correct respiratory motion. The reconstruction for six-degree of freedom rigid-body motion estimation was done in two ways: (1) using three iterations of ordered-subsets expectation-maximization (OSEM) with four subsets (16 projection angles per subset), or 12 iterations of maximum-likelihood expectation-maximization (MLEM). Respiratory motion compensation was done employing either OSEM with 16 subsets (four projection angles per subset) and five iterations or MLEM and 80 iterations, using the two respiratory estimates, respectively. Polar map quantification was also performed, calculating the percentage count difference (%Diff) between polar maps without and with respiratory motion included. Average % Diff was calculated in 17 segments (defined according to ASNC Guidelines). Paired t-tests were used to determine significance (p-values).

RESULTS

The r-value calculated when comparing the VTS and COM respiratory signals varied widely between -0.01 and 0.96 with an average of 0.70, while the SEE varied between 0.80 and 6.48 mm with an average of 2.05 mm for our patient set, while the same values for the one anthropomorphic phantom acquisition are 0.91 and 1.11 mm, respectively. A comparison between the respiratory motion estimates for VTS and COM in the S-I direction yielded an r = 0.90 (0.94), and an SEE of 1.56 mm (1.20 mm) for OSEM (MLEM), respectively. Bland-Altman plots and calculated intraclass correlation coefficients also showed excellent agreement between the VTS and COM respiratory motion estimates. Average S-I respiratory estimates for the VTS (COM) were 9.04 (9.2 mm) and 9.01 mm (9.14 mm) for the OSEM and MLEM, respectively. The paired t-test approached significance when comparing VTS and COM estimated respiratory signals with p-values of 0.069 and 0.051 for OSEM and MLEM. The respiratory estimates from the anthropomorphic cardiac phantom experiment using the VTS (COM) were 12.62 (14.10 mm) and 12.55 mm (14.29 mm) for OSEM and MLEM, respectively. Polar map quantification yielded average % Diff consistently better when employing VTS-derived respiratory estimates to correct for respiration compared to the COM-derived estimates.

CONCLUSIONS

The results indicate that our COM method has the potential to provide an automated data-driven correction of cardiac respiratory motion without the drawbacks of our VTS methodology. However, it is not generally equivalent to the VTS method in extent of correction.

Improved Performance of a Multipinhole SPECT for DAT Imaging by Increasing Number of Pinholes at the Expense of Increased Multiplexing

SPECT imaging of dopamine transporters (DAT) in the brain is a widely utilized study to improve the diagnosis of Parkinsonian syndromes, where conventional (parallel-hole and fan-beam) collimators on dual-head scanners are commonly employed. We have designed a multi-pinhole (MPH) collimator to improve the performance of DAT imaging. The MPH collimator focuses on the striatum and hence offers a better trade-off for sensitivity and spatial resolution than the conventional collimators within this clinically most relevant region for DAT imaging. Our original MPH design consisted of 9 pinholes with a background-to-striatal (Bkg/Str) projection multiplexing of 1% only. In this simulation study, we investigated whether further improvements in the performance of MPH imaging could be obtained by increasing the number of pinholes, hence by enhancing the sensitivity and sampling, despite the ambiguity in reconstructing images due to increased multiplexing. We performed analytic simulations of the MPH configurations with 9, 13, and 16 pinholes (aperture diameters: 4-6mm) using a digital phantom modeling DAT imaging. Our quantitative analyses indicated that using 13 (Bkg/Str: 12%) and 16 (Bkg/Str: 22%) pinholes provided better performance than the original 9-pinhole configuration for the acquisition with 2 or 4 angular views, but a similar performance with 8 and 16 views.

Cerebral SPECT imaging with different acquisition schemes using varying levels of multiplexing versus sensitivity in an adaptive multi-pinhole brain-dedicated scanner

Application of multi-pinhole collimator in pinhole-based SPECT increases detection sensitivity. The presence of multiplexing in projection images due to the usage of multiple pinholes can further improve the sensitivity at the cost of adding data ambiguity. We are developing a next-generation adaptive brain-dedicated SPECT system -AdaptiSPECT-C. The AdaptiSPECT-C can adapt the multiplexing level and system sensitivity using adaptable pinhole modules. In this study, we investigated the performance of 4 data acquisition schemes with different multiplexing levels and sensitivities on cerebral SPECT imaging. Schemes #1, #2, and #3 have <1%, 67%, and 31% overall multiplexing, respectively, while the 4th scheme without multiplexing is considered as ground truth. The ground-truth and schemes #1-3 have 1.0, 1.7, 5.1, and 4.0 times higher sensitivity, respectively, compared to a dual-headed parallel-hole SPECT system at matched spatial resolution. A customized XCAT brain perfusion digital phantom emulating the distribution of I-123 N-isopropyl iodoamphetamine (IMP) in a 99th percentile size male was used for simulations. Data acquisition for each scheme was performed at two count levels (low-count and high-count relative to the recommended clinical count level). The normalized root-mean-square error (NRMSE) for schemes #1, #2, and #3 with the low-count (high-count) scenario showed 11%, 4%, and 5% (10%, 5%, and 6%) deviation, respectively, from that of the multiplex-free ground truth. For both the low-count and high-count scenarios, scheme #1 resulted in the least accurate activity ratio (AR) for almost all the analyzed gray-matter brain regions. Further schemes #2 or #3 led to the most accurate AR values with both low-count and high-count scenarios for all the analyzed gray-matter regions. It was thus observed that even with this large head size which leads to significant multiplexing levels, the higher sensitivity from multiplexing could to some extent mitigate the data ambiguity and be translated into reconstructed images of higher quality.

A novel deep-learning-based approach for automatic reorientation of 3D cardiac SPECT images

PURPOSE

Reconstructed transaxial cardiac SPECT images need to be reoriented into standard short-axis slices for subsequent accurate processing and analysis. We proposed a novel deep-learning-based method for fully automatic reorientation of cardiac SPECT images and evaluated its performance on data from two clinical centers.

METHODS

We used a convolutional neural network to predict the 6 rigid-body transformation parameters and a spatial transformation network was then implemented to apply these parameters on the input images for image reorientation. A novel compound loss function which balanced the parametric similarity and penalized discrepancy of the prediction and training dataset was utilized in the training stage. Data from a set of 322 patients underwent data augmentation to 6440 groups of images for the network training, and a dataset of 52 patients from the same center and 23 patients from another center were used for evaluation. Similarity of the 6 parameters was analyzed between the proposed and the manual methods. Polar maps were generated from the output images and the averaged count values of the 17 segments were computed from polar maps to evaluate the quantitative accuracy of the proposed method.

RESULTS

All the testing patients achieved automatic reorientation successfully. Linear regression results showed the 6 predicted rigid parameters and the average count value of the 17 segments having good agreement with the reference manual method. No significant difference by paired t-test was noticed between the rigid parameters of our method and the manual method (p > 0.05). Average count values of the 17 segments show a smaller difference of the proposed and manual methods than those between the existing and manual methods.

CONCLUSION

The results strongly indicate the feasibility of our method in accurate automatic cardiac SPECT reorientation. This deep-learning-based reorientation method has great promise for clinical application and warrants further investigation.

Retrospective fractional dose reduction in Tc-99m cardiac perfusion SPECT/CT patients: A human and model observer study

BACKGROUND

In the ongoing efforts to reduce cardiac perfusion dose (injected radioactivity) for conventional SPECT/CT systems, we performed a human observer study to confirm our clinical model observer findings that iterative reconstruction employing OSEM (ordered-subset expectation-maximization) at 25% of the full dose (quarter-dose) has a similar performance for detection of hybrid cardiac perfusion defects as FBP at full dose.

METHODS

One hundred and sixty-six patients, who underwent routine rest-stress Tc-99m sestamibi cardiac perfusion SPECT/CT imaging and clinically read as normally perfused, were included in the study. Ground truth was established by the normal read and the insertion of hybrid defects. In addition to the reconstruction of the 25% of full-dose data using OSEM with attenuation (AC), scatter (SC), and spatial resolution correction (RC), FBP and OSEM (with AC, SC, and RC) both at full dose (100%) were done. Both human observer and clinical model observer confidence scores were obtained to generate receiver operating characteristics (ROC) curves in a task-based image quality assessment.

RESULTS

Average human observer AUC (area under the ROC curve) values of 0.725, 0.876, and 0.890 were obtained for FBP at full dose, OSEM at 25% of full dose, and OSEM at full dose, respectively. Both OSEM strategies were significantly better than FBP with P values of 0.003 and 0.01 respectively, while no significant difference was recorded between OSEM methods (P = 0.48). The clinical model observer results were 0.791, 0.822, and 0.879, respectively, for the same patient cases and processing strategies used in the human observer study.

CONCLUSIONS

Cardiac perfusion SPECT/CT using OSEM reconstruction at 25% of full dose has AUCs larger than FBP and closer to those of full-dose OSEM when read by human observers, potentially replacing the higher dose studies during clinical reading.

Improvement in sampling and modulation of multiplexing with temporal shuttering of adaptable apertures in a brain-dedicated multi-pinhole SPECT system

We are developing a multi-detector pinhole-based stationary brain-dedicated SPECT system: AdaptiSPECT-C. In this work, we introduced a new design prototype with multiple adaptable pinhole apertures for each detector to modulate the multiplexing by employing temporal shuttering of apertures. Temporal shuttering of apertures over the scan time provides the AdaptiSPECT-C with the capability of multiple-frame acquisition. We investigated, through analytic simulation, the impact of projection multiplexing on image quality using several digital phantoms and a customized anthropomorphic phantom emulating brain perfusion clinical distribution. The 105 pinholes in the collimator of the system were categorized into central, axial, and lateral apertures. We generated, through simulation, collimators of different multiplexing levels. Several data acquisition schemes were also created by changing the imaging time share of the acquisition frames. Sensitivity increased by 35% compared to the single-pinhole-per-detector base configuration of the AdaptiSPECT-C when using the central, axial, and lateral apertures with equal acquisition time shares within a triple-frame scheme with a high multiplexing scenario. Axial and angular sampling of the base configuration was enhanced by adding the axial and lateral apertures. We showed that the temporal shuttering of apertures can be exploited, trading the sensitivity, to modulate the multiplexing and to acquire a set of non-multiplexed non-truncated projections. Our results suggested that reconstruction benefited from utilizing both non-multiplexed projections and projections with modulated multiplexing resulting in a noticeably reduction in the multiplexing-induced image artefacts. Contrast recovery factor improved by 20% (9%) compared to the base configuration for a Defrise (hot-rod) phantom study when the central and axial (lateral) apertures with equal time shares were combined. The results revealed that, as an overall trend at each simulated multiplexing level, lowest normalized root-mean-square errors for the brain gray-matter regions were achieved with the combined usage of the central apertures and axial/lateral apertures.

Migratory earthquake precursors are dominant on an ice stream fault

Simple fault models predict earthquake nucleation near the eventual hypocenter (self-nucleation). However, some earthquakes have migratory foreshocks and possibly slow slip that travel large distances toward the eventual mainshock hypocenter (migratory nucleation). Scarce observations of migratory nucleation may result from real differences between faults or merely observational limitations. We use Global Positioning System and passive seismic records of the easily observed daily ice stream earthquake cycle of the Whillans Ice Plain, West Antarctica, to quantify the prevalence of migratory versus self-nucleation in a large-scale, natural stick-slip system. We find abundant and predominantly migratory precursory slip, whereas self-nucleation is nearly absent. This demonstration that migratory nucleation exists on a natural fault implies that more-observable migratory precursors may also occur before some earthquakes.

Surface acceleration transmission during drop landings in humans

The purpose of this study was to quantify the magnitude and frequency content of surface-measured accelerations at each major human body segment from foot to head during impact landings. Twelve males performed two single leg drop landings from each of 0.15 m, 0.30 m, and 0.45 m. Triaxial accelerometers (2000 Hz) were positioned over the: first metatarsophalangeal joint; distal anteromedial tibia; superior to the medial femoral condyle; L5 vertebra; and C6 vertebra. Analysis of acceleration signal power spectral densities revealed two distinct components, 2-14 Hz and 14-58 Hz, which were assumed to correspond to time domain signal joint rotations and elastic wave tissue deformation, respectively. Between each accelerometer position from the metatarsophalangeal joint to the L5 vertebra, signals exhibited decreased peak acceleration, increased time to peak acceleration, and decreased power spectral density integral of both the 2-14 Hz and 14-58 Hz components, with no further attenuation beyond the L5 vertebra. This resulted in peak accelerations close to vital organs of less than 10% of those at the foot. Following landings from greater heights, peak accelerations measured distally were greater, as was attenuation prior to the L5 position. Active and passive mechanisms within the lower limb therefore contribute to progressive attenuation of accelerations, preventing excessive accelerations from reaching the torso and head, even when distal accelerations are large.

Inclusion of quasi-vertex views in a brain-dedicated multi-pinhole SPECT system for improved imaging performance

With brain-dedicated multi-detector systems employing pinhole apertures the usage of detectors facing the top of the patient's head (i.e. quasi-vertex (QV) views) can provide the advantage of additional viewing from close to the brain for improved detector coverage. In this paper, we report the results of simulation and reconstruction studies to investigate the impact of the QV views on the imaging performance of AdaptiSPECT-C, a brain-dedicated stationary SPECT system under development. In this design, both primary and scatter photons from regions located inferior to the brain can contribute to SPECT projections acquired by the QV views, and thus degrade AdaptiSPECT-C imaging performance. In this work, we determined the proportion, origin, and nature (i.e. primary, scatter, and multiple-scatter) of counts emitted from structures within the head and throughout the body contributing to projections from the different AdaptiSPECT-C detector rings, as well as from a true vertex view detector. We simulated phantoms used to assess different aspects of image quality (i.e. uniform activity concentration sphere, and Derenzo), as well as anthropomorphic phantoms with different count levels emulating clinical ¹²³I activity distributions (i.e. DaTscan and perfusion). We determined that attenuation and scatter in the patient's body greatly diminish the probability of the photons emitted outside the volume of interest reaching to detectors and being recorded within the 15% photopeak energy window. In addition, we demonstrated that the inclusion of the residual of such counts in the system acquisition does not degrade visual interpretation or quantitative analysis. The addition of the QV detectors improves volumetric sensitivity, angular sampling, and spatial resolution leading to significant enhancement in image quality, especially in the striato-thalamic and superior regions of the brain. Besides, the use of QV detectors improves the recovery of clinically relevant metrics such as the striatal binding ratio and mean activity in selected cerebral structures. Our findings proving the usefulness of the QV ring for brain imaging with ¹²³I agents can be generalized to other commonly used SPECT imaging agents labelled with isotopes, such as ^99mTc and likely ¹¹¹In.

Investigation of Axial and Angular Sampling in Multi-Detector Pinhole-SPECT Brain Imaging

We designed a dedicated multi-detector multi-pinhole brain SPECT scanner to generate images of higher quality compared to general-purpose systems. The system, AdaptiSPECT-C, is intended to adapt its sensitivity-resolution trade-off by varying its aperture configurations allowing both high-sensitivity dynamic and high-spatial-resolution static imaging. The current system design consists of 23 detector heads arranged in a truncated spherical geometry. In this work, we investigated the axial and angular sampling capability of the current stationary system design. Two data acquisition schemes using limited rotation of the gantry and two others using axial translation of the imaging bed were also evaluated concerning their impact on image quality through improved sampling. Increasing both angular and axial sampling in the current prototype system resulted in quantitative improvements in image quality metrics and qualitative appearance of the images as determined in studies with specifically selected phantoms. Visual improvements for the brain phantoms with clinical distributions were less pronounced but presented quantitative improvements in the fidelity (normalized root-mean-square error (NRMSE)) and striatal specific binding ratio (SBR) for a dopamine transporter (DAT) distribution, and in NRMSE and activity recovery for a brain perfusion distribution. More pronounced improvements with increased sampling were seen in contrast recovery coefficient, bias, and coefficient of variation for a lesion in the brain perfusion distribution. The negligible impact of the most cranial ring of detectors on axial sampling, but its significant impact on sensitivity and angular sampling in the cranial portion of the imaging volume-of-interest were also determined.

Deep learning with noise-to-noise training for denoising in SPECT myocardial perfusion imaging

PURPOSE

Post-reconstruction filtering is often applied for noise suppression due to limited data counts in myocardial perfusion imaging (MPI) with single-photon emission computed tomography (SPECT). We study a deep learning (DL) approach for denoising in conventional SPECT-MPI acquisitions, and investigate whether it can be more effective for improving the detectability of perfusion defects compared to traditional postfiltering.

METHODS

Owing to the lack of ground truth in clinical studies, we adopt a noise-to-noise (N2N) training approach for denoising in SPECT-MPI images. We consider a coupled U-Net (CU-Net) structure which is designed to improve learning efficiency through feature map reuse. For network training we employ a bootstrap procedure to generate multiple noise realizations from list-mode clinical acquisitions. In the experiments we demonstrated the proposed approach on a set of 895 clinical studies, where the iterative OSEM algorithm with three-dimensional (3D) Gaussian postfiltering was used to reconstruct the images. We investigated the detection performance of perfusion defects in the reconstructed images using the non-prewhitening matched filter (NPWMF), evaluated the uniformity of left ventricular (LV) wall in terms of image intensity, and quantified the effect of smoothing on the spatial resolution of the reconstructed LV wall by using its full-width at half-maximum (FWHM).

RESULTS

Compared to OSEM with Gaussian postfiltering, the DL denoised images with CU-Net significantly improved the detection performance of perfusion defects at all contrast levels (65%, 50%, 35%, and 20%). The signal-to-noise ratio (SNR_D ) in the NPWMF output was increased on average by 8% over optimal Gaussian smoothing (P < 10^-4 , paired t-test), while the inter-subject variability was greatly reduced. The CU-Net also outperformed a 3D nonlocal means (NLM) filter and a convolutional autoencoder (CAE) denoising network in terms of SNR_D . In addition, the FWHM of the LV wall in the reconstructed images was varied by less than 1%. Furthermore, CU-Net also improved the detection performance when the images were processed with less post-reconstruction smoothing (a trade-off of increased noise for better LV resolution), with SNR_D improved on average by 23%.

CONCLUSIONS

The proposed DL with N2N training approach can yield additional noise suppression in SPECT-MPI images over conventional postfiltering. For perfusion defect detection, DL with CU-Net could outperform conventional 3D Gaussian filtering with optimal setting as well as NLM and CAE.

The clinical utilities of multi-pinhole single photon emission computed tomography

Single photon emission computed tomography (SPECT) is an important imaging modality for various applications in nuclear medicine. The use of multi-pinhole (MPH) collimators can provide superior resolution-sensitivity trade-off when imaging small field-of-view compared to conventional parallel-hole and fan-beam collimators. Besides the very successful application in small animal imaging, there has been a resurgence of the use of MPH collimators for clinical cardiac and brain studies, as well as other small field-of-view applications. This article reviews the basic principles of MPH collimators and introduces currently available and proposed clinical MPH SPECT systems.

Improving Diagnostic Accuracy in Low-Dose SPECT Myocardial Perfusion Imaging With Convolutional Denoising Networks

Lowering the administered dose in SPECT myocardial perfusion imaging (MPI) has become an important clinical problem. In this study we investigate the potential benefit of applying a deep learning (DL) approach for suppressing the elevated imaging noise in low-dose SPECT-MPI studies. We adopt a supervised learning approach to train a neural network by using image pairs obtained from full-dose (target) and low-dose (input) acquisitions of the same patients. In the experiments, we made use of acquisitions from 1,052 subjects and demonstrated the approach for two commonly used reconstruction methods in clinical SPECT-MPI: 1) filtered backprojection (FBP), and 2) ordered-subsets expectation-maximization (OSEM) with corrections for attenuation, scatter and resolution. We evaluated the DL output for the clinical task of perfusion-defect detection at a number of successively reduced dose levels (1/2, 1/4, 1/8, 1/16 of full dose). The results indicate that the proposed DL approach can achieve substantial noise reduction and lead to improvement in the diagnostic accuracy of low-dose data. In particular, at 1/2 dose, DL yielded an area-under-the-ROC-curve (AUC) of 0.799, which is nearly identical to the AUC = 0.801 obtained by OSEM at full-dose ( p -value = 0.73); similar results were also obtained for FBP reconstruction. Moreover, even at 1/8 dose, DL achieved AUC = 0.770 for OSEM, which is above the AUC = 0.755 obtained at full-dose by FBP. These results indicate that, compared to conventional reconstruction filtering, DL denoising can allow for additional dose reduction without sacrificing the diagnostic accuracy in SPECT-MPI.

Pharmacological targeting of striatal indirect pathway neurons improves subthalamic nucleus dysfunction and reduces repetitive behaviors in C58 mice

Repetitive behaviors (e.g., stereotypic movements, compulsions, rituals) are common features of a number of neurodevelopmental disorders. Clinical and animal model studies point to the importance of cortical-basal ganglia circuitry in the mediation of repetitive behaviors. In the current study, we tested whether a drug cocktail (dopamine D2 receptor antagonist + adenosine A2A receptor agonist + glutamate mGlu5 positive allosteric modulator) designed to activate the indirect basal ganglia pathway would reduce repetitive behavior in C58 mice after both acute and sub-chronic administration. In addition, we hypothesized that sub-chronic administration (i.e. 7 days of twice-daily injections) would increase the functional activation of the subthalamic nucleus (STN), a key node of the indirect pathway. Functional activation of STN was indexed by dendritic spine density, analysis of GABA, glutamate, and synaptic plasticity genes, and cytochrome oxidase activity. The drug cocktail used significantly reduced repetitive motor behavior in C58 mice after one night as well as seven nights of twice-nightly injections. These effects did not reflect generalized motor behavior suppression as non-repetitive motor behaviors such as grooming, digging and eating were not reduced relative to vehicle. Sub-chronic drug treatment targeting striatopallidal neurons resulted in significant changes in the STN, including a four-fold increase in brain-derived neurotrophic factor (BDNF) mRNA expression as well as a significant increase in dendritic spine density. The present findings are consistent with, and extend, our prior work linking decreased functioning of the indirect basal ganglia pathway to expression of repetitive motor behavior in C58 mice and suggest novel therapeutic targets.

Evaluation of different respiratory gating schemes for cardiac SPECT

BACKGROUND

Respiratory gating reduces motion blurring in cardiac SPECT. Here we aim to evaluate the performance of three respiratory gating strategies using a population of digital phantoms with known truth and clinical data.

METHODS

We analytically simulated 60 projections for 10 XCAT phantoms with 99mTc-sestamibi distributions using three gating schemes: equal amplitude gating (AG), equal count gating (CG), and equal time gating (TG). Clinical list-mode data for 10 patients who underwent 99mTc-sestamibi scans were also processed using the 3 gating schemes. Reconstructed images in each gate were registered to a reference gate, averaged and reoriented to generate the polar plots. For simulations, image noise, relative difference (RD) of averaged count for each of the 17 segment, and relative defect size difference (RSD) were analyzed. For clinical data, image intensity profile and FWHM were measured across the left ventricle wall.

RESULTS

For simulations, AG and CG methods showed significantly lower RD and RSD compared to TG, while noise variation was more non-uniform through different gates for AG. In the clinical study, AG and CG had smaller FWHM than TG.

CONCLUSIONS

AG and CG methods show better performance for motion reduction and are recommended for clinical respiratory gating SPECT implementation.

Evaluation of the effect of reducing administered activity on assessment of function in cardiac gated SPECT

BACKGROUND

We previously optimized several reconstruction strategies in SPECT myocardial perfusion imaging (MPI) with low dose for perfusion-defect detection. Here we investigate whether reducing the administered activity can also maintain the diagnostic accuracy in evaluating cardiac function.

METHODS

We quantified the myocardial motion in cardiac-gated stress 99m-Tc-sestamibi SPECT studies from 163 subjects acquired with full dose (29.8 ± 3.6 mCi), and evaluated the agreement of the obtained motion/thickening and ejection fraction (EF) measures at various reduced dose levels (uniform reduction or personalized dose) with that at full dose. We also quantified the detectability of abnormal motion via a receiver-operating characteristics (ROC) study. For reconstruction we considered both filtered backprojection (FBP) without correction for degradations, and iterative ordered-subsets expectation-maximization (OS-EM) with resolution, attenuation and scatter corrections.

RESULTS

With dose level lowered to 25% of full dose, the obtained results on motion/thickening, EF and abnormal motion detection were statistically comparable to full dose in both reconstruction strategies, with Pearson's r > 0.9 for global motion measures between low dose and full dose.

CONCLUSIONS

The administered activity could be reduced to 25% of full dose without degrading the function assessment performance. Low dose reconstruction optimized for perfusion-defect detection can be reasonable for function assessment in gated SPECT.

Investigation of the physical effects of respiratory motion compensation in a large population of patients undergoing Tc-99m cardiac perfusion SPECT/CT stress imaging

BACKGROUND

Respiratory motion can deteriorate image fidelity in cardiac perfusion SPECT. We determined the extent of respiratory motion, assessed its impact on image fidelity, and investigated the existence of gender differences, thereby examining the influence of respiratory motion in a large population of patients.

METHODS

One thousand one hundred and three SPECT/CT patients underwent visual tracking of markers on their anterior surface during stress acquisition to track respiratory motion. The extent of motion was estimated by registration. Visual indicators of changes in cardiac slices with motion correction, and the correlation between the extent of motion with changes in segmental-counts were assessed.

RESULTS

Respiratory motion in the head-to-feet direction was the largest component of motion, varying between 1.1 and 37.4 mm, and was statistically significantly higher (p = 0.002) for males than females. In 33.0% of the patients, motion estimates were larger than 10 mm. Patients progressively show more distinct visual changes with an increase in the extent of motion. The increase in segmental-count differences in the anterior, antero-lateral, and inferior segments correlated with the extent of motion.

CONCLUSIONS

Respiratory motion correction diminished the artefactual reduction in anterior and inferior wall counts associated with respiratory motion. The extent of improvement was strongly related to the magnitude of motion.

Primary, scatter, and penetration characterizations of parallel-hole and pinhole collimators for I-123 SPECT

Multi-pinhole (MPH) collimators are known to provide better trade-off between sensitivity and resolution for preclinical, as well as for smaller regions in clinical SPECT imaging compared to conventional collimators. In addition to this geometric advantage, MPH plates typically offer better stopping power for penetration than the conventional collimators, which is especially relevant for I-123 imaging. The I-123 emits a series of high-energy (>300 keV, ~2.5% abundance) gamma photons in addition to the primary emission (159 keV, 83% abundance). Despite their low abundance, high-energy photons penetrate through a low-energy parallel-hole (LEHR) collimator much more readily than the 159 keV photons, resulting in large downscatter in the photopeak window. In this work, we investigate the primary, scatter, and penetration characteristics of a single pinhole collimator that is commonly used for I-123 thyroid imaging and our two MPH collimators designed for I-123 DaTscan imaging for Parkinson's Disease, in comparison to three different parallel-hole collimators through a series of experiments and Monte Carlo simulations. The simulations of a point source and a digital human phantom with DaTscan activity distribution showed that our MPH collimators provide superior count performance in terms of high primary counts, low penetration, and low scatter counts compared to the parallel-hole and single pinhole collimators. For example, total scatter, multiple scatter, and collimator penetration events for the LEHR were 2.5, 7.6 and 14 times more than that of MPH within the 15% photopeak window. The total scatter fraction for LEHR was 56% where the largest contribution came from the high-energy scatter from the back compartments (31%). For the same energy window, the total scatter for MPH was 21% with only 1% scatter from the back compartments. We therefore anticipate that using MPH collimators, higher quality reconstructions can be obtained in a substantially shorter acquisition time for I-123 DaTscan and thyroid imaging.

Improving perfusion defect detection with respiratory motion correction in cardiac SPECT at standard and reduced doses

BACKGROUND

In cardiac SPECT perfusion imaging, respiratory motion can cause non-uniform blurring in the reconstructed myocardium. We investigate the potential benefit of respiratory correction with respiratory-binned acquisitions, both at standard dose and at reduced dose, for defect detection and for left ventricular (LV) wall resolution.

METHODS

We applied two reconstruction methods for respiratory motion correction: post-reconstruction motion correction (PMC) and motion-compensated reconstruction (MCR), and compared with reconstruction without motion correction (Non-MC). We quantified the presence of perfusion defects in reconstructed images by using the total perfusion deficit (TPD) scores and conducted receiver-operating-characteristic (ROC) studies using TPD. We quantified the LV spatial resolution by using the FWHM of its cross-sectional intensity profile.

RESULTS

The values in the area-under-the-ROC-curve (AUC) achieved by MCR, PMC, and Non-MC at standard dose were 0.835, 0.830, and 0.798, respectively. Similar AUC improvements were also obtained by MCR and PMC over Non-MC at 50%, 25%, and 12.5% of full dose. Improvements in LV resolution were also observed with motion correction.

CONCLUSIONS

Respiratory-binned acquisitions can improve perfusion-defect detection accuracy over traditional reconstruction both at standard dose and at reduced dose. Motion correction may contribute to achieving further dose reduction while maintaining the diagnostic accuracy of traditional acquisitions.

MRI of Whole Rat Brain Perivascular Network Reveals Role for Ventricles in Brain Waste Clearance

Investigating the mechanisms by which metabolic wastes are cleared from nervous tissue is important for understanding natural function and the pathophysiology of several neurological disorders including Alzheimer's disease. Recent evidence suggests clearance may be the function of annular spaces around cerebral blood vessels, called perivascular spaces (PVS), through which cerebrospinal fluid (CSF) is transported from the subarachnoid space into brain parenchyma to exchange with interstitial fluid (also known as the glymphatic system). In this work, an MRI-based methodology was developed to reconstruct the PVS network in whole rat brain to better elucidate both PVS uptake and clearance pathways. MR visible tracer (Gd-albumin) was infused in vivo into the CSF-filled lateral ventricle followed by ex vivo high-resolution MR imaging at 17.6 T with an image voxel volume two orders of magnitude smaller than previously reported. Imaged tracer distribution patterns were reconstructed to obtain a more complete brain PVS network. Several PVS connections were repeatedly highlighted across different animals, and new PVS connections between ventricles and different parts of the brain parenchyma were revealed suggesting a possible role for the ventricles as a source or sink for solutes in the brain. In the future, this methodology may be applied to understand changes in the PVS network with disease.

Personalized Models for Injected Activity Levels in SPECT Myocardial Perfusion Imaging

We propose a patient-specific ("personalized") approach for tailoring the injected activities to individual patients in order to achieve dose reduction in SPECT-myocardial perfusion imaging (MPI). First, we develop a strategy to determine the minimum dose levels required for each patient in a large set of clinical acquisitions (857 subjects) such that the reconstructed images are sufficiently similar to that obtained at conventional clinical dose. We then apply machine learning models to predict the required dose levels on an individual basis based on a set of patient attributes which include body measurements and various clinical variables. We demonstrate the personalized dose models for two commonly used reconstruction methods in clinical SPECT-MPI: 1) conventional filtered backprojection (FBP) with post-filtering and 2) ordered-subsets expectation-maximization (OS-EM) with corrections for attenuation, scatter and resolution, and evaluate their performance in perfusion-defect detection by using the clinical Quantitative Perfusion SPECT software package. The results indicate that the achieved dose reduction can vary greatly among individuals from their conventional clinical dose and that the personalized dose models can achieve further reduction on average compared with a global (non-patient specific) dose reduction approach. In particular, the average personalized dose level can be reduced to 58% and 54% of the full clinical dose, respectively, for FBP and OS-EM reconstruction, while without deteriorating the accuracy in perfusion-defect detection. Furthermore, with the average personalized dose further reduced to only 16% of full dose, OS-EM can still achieve a detection accuracy level comparable to that of FBP with full dose.

Cardiac motion correction for improving perfusion defect detection in cardiac SPECT at standard and reduced doses of activity

In cardiac SPECT perfusion imaging, cardiac motion can lead to motion blurring of anatomical detail and perfusion defects in the reconstructed myocardium. In this study, we investigated the potential benefit of cardiac motion correction for improving the detectability of perfusion defects. We considered a post-reconstruction motion correction (PMC) approach in which the image motion between two cardiac gates is obtained with optical flow estimation. In the experiments, we demonstrated the proposed post-reconstruction motion correction with optical flow estimation (PMC-OFE) approach on a set of clinical acquisitions from 194 subjects. We quantified the detectability of perfusion defects in the reconstructed images by using the total perfusion deficit scores, calculated by the clinical software tool QPS, and conducted a receiver-operating-characteristic (ROC) study to obtain the detection performance. Besides imaging with conventional standard dose, we also evaluated the approach for reduced dose SPECT imaging where the imaging dose was retrospectively reduced to 50%, 25%, and 12.5% of the standard dose. The proposed PMC-OFE approach achieved at each dose level higher area-under-the-ROC-curve (AUC) for perfusion defect detection than the traditional approach of using ungated data (Non-MC) (p -value  <  0.05); in particular, with half dose, PMC-OFE achieved AUC  =  0.813, which is comparable to Non-MC with standard dose (AUC  =  0.795). Moreover, the proposed PMC-OFE approach also outperformed the 'Motion Frozen' (MF) method implemented in the clinical quantitative gated SPECT (QGS) software. In particular, at 25% and 12.5% of standard dose, the AUC values obtained by PMC-OFE are 0.788 and 0.779, respectively, compared to 0.758 and 0.731 for MF (p -value  <  0.05).

Investigation of dose reduction in cardiac perfusion SPECT via optimization and choice of the image reconstruction strategy

BACKGROUND

We investigated the extent to which the administered dose (activity) level can be reduced without sacrificing diagnostic accuracy for three reconstruction strategies for SPECT-myocardial perfusion imaging (MPI).

METHODS

We optimized the parameters of the three reconstruction strategies for perfusion-defect detection over a range of simulated administered dose levels using a set of hybrid studies (derived from 190 subjects) consisting of clinical SPECT-MPI data modified to contain realistic simulated lesions. The optimized strategies we considered are filtered backprojection (FBP) with no correction for degradations, ordered-subsets expectation-maximization (OS-EM) with attenuation correction (AC), scatter correction (SC), and resolution correction (RC), and OS-EM with scatter and resolution correction only. Each study was evaluated using a total perfusion deficit (TPD) score computed by the Quantitative Perfusion SPECT (QPS) software package. We conducted a receiver operating characteristics (ROC) study based on the TPD scores for each dose level and reconstruction strategy.

RESULTS

For FBP, the achieved optimum values of the area under the ROC curve (AUC) at 100%, 50%, 25%, and 12.5% of standard dose were 0.75, 0.74, 0.72, and 0.70, respectively, compared to 0.81, 0.79, 0.76, and 0.74 for OS-EM with AC-SC-RC and 0.78, 0.77, 0.74, 0.72 for OS-EM with SC-RC.

CONCLUSIONS

Our results suggest that studies reconstructed by OS-EM with AC-SC-RC could possibly be reduced, on average, to 25% of the originally administered dose without causing diagnostic accuracy (AUC) to decrease below that of FBP.

Comparison of biomechanical characteristics between male and female elite fast bowlers

This study investigated ball release speed and performance kinematics between elite male and female cricket fast bowlers. Fifty-five kinematic parameters were collected for 20 male and 20 female elite fast bowlers. Group means were analysed statistically using an independent samples approach to identify differences. Significant differences were found between: ball release speed; run-up speed; the kinematics at back foot contact (BFC), front foot contact (FFC), and ball release (BR); and the timings between these key instants. These results indicate that the female bowlers generated less whole body linear momentum during the run-up than the males. The male bowlers also utilised a technique between BFC and FFC which more efficiently maintained linear momentum compared to the females. As a consequence of this difference in linear momentum at FFC, the females typically adopted a technique more akin to throwing where ball release speed was contributed to by both the whole body angular momentum and the large rotator muscles used to rotate the pelvis and torso segments about the longitudinal axis. This knowledge is likely to be useful in the coaching of female fast bowlers although future studies are required to understand the effects of anthropometric and strength constraints on fast bowling performance.

Simulations of a Multi-Pinhole SPECT Collimator for Clinical Dopamine Transporter (DAT) Imaging

SPECT imaging of the dopamine transporter (DAT) is used for diagnosis and monitoring progression of Parkinson's Disease (PD), and differentiation of PD from other neurological disorders. The diagnosis is based on the DAT binding in the caudate and putamen structures in the striatum. We previously proposed a relatively inexpensive method to improve the detection and quantification of these structures for dual-head SPECT by replacing one of the fan-beam collimators with a specially designed multi-pinhole (MPH) collimator. In this work, we developed a realistic model of the proposed MPH system using the GATE simulation package and verified the geometry with an analytic simulator. Point source projections from these simulations closely matched confirming the accuracy of the pinhole geometries. The reconstruction of a hot-rod phantom showed that 4.8 mm resolution is achievable. The reconstructions of the XCAT brain phantom showed clear separation of the putamen and caudate, which is expected to improve the quantification of DAT imaging and PD diagnosis. Using this GATE model, point spread functions modeling physical factors will be generated for use in reconstruction. Also, further improvements in geometry are being investigated to increase the sensitivity of this base system while maintaining a target spatial resolution of 4.5-5 mm.

Kinematic parameters contributing to the production of spin in elite finger spin bowling

The aim of this study was to identify the key kinematic parameters which contribute to higher spin rates in elite finger spin bowling. Kinematic data were collected for twenty-three elite male finger spin bowlers with thirty kinematic parameters calculated for each delivery. Stepwise linear regression and Pearson product moment correlations were used to identify kinematic parameters linked to spin rate. Pelvis orientation at front foot contact (r = 0.674, p < 0.001) and ball release (r = 0.676, p < 0.001) were found to be the biggest predictors of spin rate, with both individually predicting 43% of the observed variance in spin rate. Other kinematic parameters correlated with spin rate included: shoulder orientation at ball release (r = 0.462, p = 0.027), and pelvis-shoulder separation angle at front foot contact (r = 0.521, p = 0.011). The bowlers with the highest spin rates adopted a mid-way pelvis orientation angle, a larger pelvis-shoulder separation angle and a shoulder orientation short of side-on at front foot contact. The segments then rotated sequentially, starting with the pelvis and finishing with the pronation of the forearm. This knowledge can be translated to coaches to provide a better understanding of finger spin bowling technique.

Motion-compensated image reconstruction vs postreconstruction correction in respiratory-binned SPECT with standard and reduced-dose acquisitions

PURPOSE

Cardiac perfusion images in single-photon emission computed tomography (SPECT) can suffer from respiratory motion blur. We investigated a reconstruction approach for correcting respiratory motion in respiratory-binned acquisitions and assessed the benefit of this approach in both standard dose and reduced dose.

METHODS

We modeled the acquired data from different respiratory bins by a joint probability distribution which was parameterized with respect to a common reference bin. The acquired data from all the respiratory bins were then utilized simultaneously for determining the source distribution in the reference bin using maximum a posteriori (MAP) estimation. We evaluated this approach with simulated imaging data and ten sets of clinical acquisitions, and compared it with a postreconstruction motion correction approach developed previously. We quantified the accuracy of the reconstruction results both at standard dose and with imaging dose reduced by 50% and 75%, respectively.

RESULTS

The proposed motion-compensated reconstruction (MCR) approach led to improved reconstruction of the myocardium in terms of both noise level and LV wall resolution. Compared to traditional acquisition (without motion correction), the proposed approach reduced the mean squared error of the image intensity in the myocardium by 27.59%, 20.59%, and 12.05% at full, half-, and quarter dose, respectively; the LV resolution, quantified by the full width at half-maximum (FWHM), was improved by 17.34%, 14.35%, and 12.95% at full, half-, and quarter dose, respectively; in addition, the proposed approach also improved the perfusion defect detectability at both full dose and reduced dose. Furthermore, with motion correction, the reconstruction results obtained at half-dose were comparable to that obtained at full dose without correction. Similar improvements were also demonstrated in the clinical acquisitions at different dose levels.

CONCLUSIONS

Respiratory motion correction in perfusion SPECT can improve the reconstruction of the myocardium at both standard and reduced dose. At half-dose, the results obtained with motion correction are comparable to that of traditional reconstruction obtained at full dose. MCR can be more accurate than postreconstruction correction.

Subthalamic nucleus pathology contributes to repetitive behavior expression and is reversed by environmental enrichment

Repetitive motor behaviors are common in neurodevelopmental, psychiatric and neurological disorders. Despite their prevalence in certain clinical populations, our understanding of the neurobiological cause of repetitive behavior is lacking. Likewise, not knowing the pathophysiology has precluded efforts to find effective drug treatments. Our comparisons between mouse strains that differ in their expression of repetitive behavior showed an important role of the subthalamic nucleus (STN). In mice with high rates of repetitive behavior, we found significant differences in dendritic spine density, gene expression and neuronal activation in the STN. Taken together, these data show a hypoglutamatergic state. Furthermore, by using environmental enrichment to reduce repetitive behavior, we found evidence of increased glutamatergic tone in the STN with our measures of spine density and gene expression. These results suggest the STN is a major contributor to repetitive behavior expression and highlight the potential of drugs that increase STN function to reduce repetitive behavior in clinical populations.

4D non-local means post-filtering for cardiac gated SPECT

Cardiac gated images often suffer from increased noise in single photon emission computed tomography (SPECT) due to reduced data counts compared to non-gated studies. We investigate a spatiotemporal post-processing approach based on a non-local means (NLM) filter for suppressing the noise in gated SPECT images. In this filter, the output at a voxel location is computed from a weighted average of voxels in its four-dimensional (4D) neighborhood, wherein the filter coefficients are adjusted according to the similarity level in the local image pattern of individual voxels with respect to the output voxel. This adaptive property allows the filter to achieve noise reduction while avoiding excessive blur of the heart wall. In the experiments, we first evaluated the accuracy of the proposed NLM filtering approach using simulated SPECT imaging data. We then demonstrated the approach on eight sets of clinical acquisitions. In addition, we also explored the robustness of the NLM filter with imaging dose reduced by 50% in these clinical acquisitions. The quantitative results show that 4D NLM filtering could effectively reduce the noise level in gated images, leading to more accurate reconstruction of the myocardium. Compared to spatial filtering alone, using temporal filtering in NLM could reduce the mean-squared-error of the myocardium by 55.63% and improve the left ventricle resolution by 19.92%. It could also improve the visibility of perfusion defects in gated images. Similar results are also observed on the clinical acquisitions both at standard dose and at 50% reduced dose. The 4D NLM results are also found to be comparable to that of a motion-compensated 4D reconstruction approach which is computationally more demanding.

4-D Reconstruction With Respiratory Correction for Gated Myocardial Perfusion SPECT

Cardiac single photon emission computed tomography (SPECT) images are known to suffer from both cardiac and respiratory motion blur. In this paper, we investigate a 4-D reconstruction approach to suppress the effect of respiratory motion in gated cardiac SPECT imaging. In this approach, the sequence of cardiac gated images is reconstructed with respect to a reference respiratory amplitude bin in the respiratory cycle. To combat the challenge of inherent high-imaging noise, we utilize the data counts acquired during the entire respiratory cycle by making use of a motion-compensated scheme, in which both cardiac motion and respiratory motion are taken into account. In the experiments, we first use Monte Carlo simulated imaging data, wherein the ground truth is known for quantitative comparison. We then demonstrate the proposed approach on eight sets of clinical acquisitions, in which the subjects exhibit different degrees of respiratory motion blur. The quantitative evaluation results show that the 4-D reconstruction with respiratory correction could effectively reduce the effect of motion blur and lead to a more accurate reconstruction of the myocardium. The mean-squared error of the myocardium is reduced by 22%, and the left ventricle (LV) resolution is improved by 21%. Such improvement is also demonstrated with the clinical acquisitions, where the motion blur is markedly improved in the reconstructed LV wall and blood pool. The proposed approach is also noted to be effective on correcting the spill-over effect in the myocardium from nearby bowel or liver activities.

Correction of hysteretic respiratory motion in SPECT myocardial perfusion imaging: Simulation and patient studies

PURPOSE

Amplitude-based respiratory gating is known to capture the extent of respiratory motion (RM) accurately but results in residual motion in the presence of respiratory hysteresis. In our previous study, we proposed and developed a novel approach to account for respiratory hysteresis by applying the Bouc-Wen (BW) model of hysteresis to external surrogate signals of anterior/posterior motion of the abdomen and chest with respiration. In this work, using simulated and clinical SPECT myocardial perfusion imaging (MPI) studies, we investigate the effects of respiratory hysteresis and evaluate the benefit of correcting it using the proposed BW model in comparison with the abdomen signal typically employed clinically.

METHODS

The MRI navigator data acquired in free-breathing human volunteers were used in the specially modified 4D NCAT phantoms to allow simulating three types of respiratory patterns: monotonic, mild hysteresis, and strong hysteresis with normal myocardial uptake, and perfusion defects in the anterior, lateral, inferior, and septal locations of the mid-ventricular wall. Clinical scans were performed using a Tc-99m sestamibi MPI protocol while recording respiratory signals from thoracic and abdomen regions using a visual tracking system (VTS). The performance of the correction using the respiratory signals was assessed through polar map analysis in phantom and 10 clinical studies selected on the basis of having substantial RM.

RESULTS

In phantom studies, simulations illustrating normal myocardial uptake showed significant differences (P < 0.001) in the uniformity of the polar maps between the RM uncorrected and corrected. No significant differences were seen in the polar map uniformity across the RM corrections. Studies simulating perfusion defects showed significantly decreased errors (P < 0.001) in defect severity and extent for the RM corrected compared to the uncorrected. Only for the strong hysteretic pattern, there was a significant difference (P < 0.001) among the RM corrections. The errors in defect severity and extent for the RM correction using abdomen signal were significantly higher compared to that of the BW (severity = -4.0%, P < 0.001; extent = -65.4%, P < 0.01) and chest (severity = -4.1%, P < 0.001; extent = -52.5%, P < 0.01) signals. In clinical studies, the quantitative analysis of the polar maps demonstrated qualitative and quantitative but not statistically significant differences (P = 0.73) between the correction methods that used the BW signal and the abdominal signal.

CONCLUSIONS

This study shows that hysteresis in respiration affects the extent of residual motion left in the RM-binned data, which can impact wall uniformity and the visualization of defects. Thus, there appears to be the potential for improved accuracy in reconstruction in the presence of hysteretic RM with the BW model method providing a possible step in the direction of improvement.

Improved frame-based estimation of head motion in PET brain imaging

PURPOSE

Head motion during PET brain imaging can cause significant degradation of image quality. Several authors have proposed ways to compensate for PET brain motion to restore image quality and improve quantitation. Head restraints can reduce movement but are unreliable; thus the need for alternative strategies such as data-driven motion estimation or external motion tracking. Herein, the authors present a data-driven motion estimation method using a preprocessing technique that allows the usage of very short duration frames, thus reducing the intraframe motion problem commonly observed in the multiple frame acquisition method.

METHODS

The list mode data for PET acquisition is uniformly divided into 5-s frames and images are reconstructed without attenuation correction. Interframe motion is estimated using a 3D multiresolution registration algorithm and subsequently compensated for. For this study, the authors used 8 PET brain studies that used F-18 FDG as the tracer and contained minor or no initial motion. After reconstruction and prior to motion estimation, known motion was introduced to each frame to simulate head motion during a PET acquisition. To investigate the trade-off in motion estimation and compensation with respect to frames of different length, the authors summed 5-s frames accordingly to produce 10 and 60 s frames. Summed images generated from the motion-compensated reconstructed frames were then compared to the original PET image reconstruction without motion compensation.

RESULTS

The authors found that our method is able to compensate for both gradual and step-like motions using frame times as short as 5 s with a spatial accuracy of 0.2 mm on average. Complex volunteer motion involving all six degrees of freedom was estimated with lower accuracy (0.3 mm on average) than the other types investigated. Preprocessing of 5-s images was necessary for successful image registration. Since their method utilizes nonattenuation corrected frames, it is not susceptible to motion introduced between CT and PET acquisitions.

CONCLUSIONS

The authors have shown that they can estimate motion for frames with time intervals as short as 5 s using nonattenuation corrected reconstructed FDG PET brain images. Intraframe motion in 60-s frames causes degradation of accuracy to about 2 mm based on the motion type.

Adeno-associated viral vector-mediated preprosomatostatin expression suppresses induced seizures in kindled rats

Somatostatin is expressed widely in the hippocampus and notably in hilar GABAergic neurons that are vulnerable to seizure neuropathology in chronic temporal lobe epilepsy. We previously demonstrated that sustained bilateral preprosomatostatin (preproSST) expression in the hippocampus prevents the development of generalized seizures in the amygdala kindling model of temporal lobe epilepsy. Here we tested whether sustained preproSST expression is anticonvulsant in rats already kindled to high-grade seizures. Rats were kindled until they exhibited 3 consecutive Racine Grade 5 seizures before adeno-associated virus serotype 5 (AAV5) vector driving either eGFP (AAV5-CBa-eGFP) or preproSST and eGFP (AAV5-CBa-preproSST-eGFP) expression was injected bilaterally into the hippocampal dentate gyrus and CA1 region. Retested 3 weeks later, rats that received control vector (AAV5-CBa-eGFP) continued to exhibit high-grade seizures whereas 6/13 rats that received preproSST vector (AAV5-CBa-preproSST-eGFP) were seizure-free. Of these rats, 5/6 remained seizure-free after repeated stimulation sessions and when the stimulation current was increased. These results suggest that vector-mediated expression of preproSST may be a viable therapeutic strategy for temporal lobe epilepsy.

Understanding Teamwork in the Provision of Cancer Care: Highlighting the Role of Trust

Team science research has indicated that trust is a critical variable of teamwork, contributing greatly to a team's performance. Trust has long been examined in health care with research focusing on the development of trust by patients with their health care practitioners. Studies have indicated that trust is linked to patient satisfaction, adherence to treatment, continuity of care, and improved outcomes. We explore the construct of trust using a case example of a patient who received a surgical procedure for a precancerous polyp. We apply the principle of trust to the case as well as present the literature on trust and key definitions for understanding trust. Additionally, we apply the definitions presented to the specific case example by highlighting moments where trust is developed or violated. Lastly, we offer insights to health care practitioners on the development of trust in their own patient interactions to improve care.

Evaluation of Rigid-Body Motion Compensation in Cardiac Perfusion SPECT Employing Polar-Map Quantification

We have recently been successful in the development and testing of rigid-body motion tracking, estimation and compensation for cardiac perfusion SPECT based on a visual tracking system (VTS). The goal of this study was to evaluate in patients the effectiveness of our rigid-body motion compensation strategy. Sixty-four patient volunteers were asked to remain motionless or execute some predefined body motion during an additional second stress perfusion acquisition. Acquisitions were performed using the standard clinical protocol with 64 projections acquired through 180 degrees. All data were reconstructed with an ordered-subsets expectation-maximization (OSEM) algorithm using 4 projections per subset and 5 iterations. All physical degradation factors were addressed (attenuation, scatter, and distance dependent resolution), while a 3-dimensional Gaussian rotator was used during reconstruction to correct for six-degree-of-freedom (6-DOF) rigid-body motion estimated by the VTS. Polar map quantification was employed to evaluate compensation techniques. In 54.7% of the uncorrected second stress studies there was a statistically significant difference in the polar maps, and in 45.3% this made a difference in the interpretation of segmental perfusion. Motion correction reduced the impact of motion such that with it 32.8 % of the polar maps were statistically significantly different, and in 14.1% this difference changed the interpretation of segmental perfusion. The improvement shown in polar map quantitation translated to visually improved uniformity of the SPECT slices.

Inhibition of cholesterol metabolism underlies synergy between mTOR pathway inhibition and chloroquine in bladder cancer cells

Mutations to fibroblast growth factor receptor 3 (FGFR3) and phosphatase and tensin homologue (PTEN) signalling pathway components (for example, PTEN loss, PIK3CA, AKT1, TSC1/2) are common in bladder cancer, yet small-molecule inhibitors of these nodes (FGFR/PTENi) show only modest activity in preclinical models. As activation of autophagy is proposed to promote survival under FGFR/PTENi, we have investigated this relationship in a panel of 18 genetically diverse bladder cell lines. We found that autophagy inhibition does not sensitise bladder cell lines to FGFR/PTENi, but newly identify an autophagy-independent cell death synergy in FGFR3-mutant cell lines between mTOR (mammalian target of rapamycin) pathway inhibitors and chloroquine (CQ)—an anti-malarial drug used as a cancer therapy adjuvant in over 30 clinical trials. The mechanism of synergy is consistent with lysosomal cell death (LCD), including cathepsin-driven caspase activation, and correlates with suppression of cSREBP1 and cholesterol biosynthesis in sensitive cell lines. Remarkably, loss of viability can be rescued by saturating cellular membranes with cholesterol or recapitulated by statin-mediated inhibition, or small interfering RNA knockdown, of enzymes regulating cholesterol metabolism. Modulation of CQ-induced cell death by atorvastatin and cholesterol is reproduced across numerous cell lines, confirming a novel and fundamental role for cholesterol biosynthesis in regulating LCD. Thus, we have catalogued the molecular events underlying cell death induced by CQ in combination with an anticancer therapeutic. Moreover, by revealing a hitherto unknown aspect of lysosomal biology under stress, we propose that suppression of cholesterol metabolism in cancer cells should elicit synergy with CQ and define a novel approach to future cancer treatments.

Design of a Multi-Pinhole Collimator for I-123 DaTscan Imaging on Dual-Headed SPECT Systems in Combination with a Fan-Beam Collimator

For the 2011 FDA approved Parkinson's Disease (PD) SPECT imaging agent I-123 labeled DaTscan, the volume of interest (VOI) is the interior portion of the brain. However imaging of the occipital lobe is also required with PD for calculation of the striatal binding ratio (SBR), a parameter of significance in early diagnosis, differentiation of PD from other disorders with similar clinical presentations, and monitoring progression. Thus we propose the usage of a combination of a multi-pinhole (MPH) collimator on one head of the SPECT system and a fan-beam on the other. The MPH would be designed to provide high resolution and sensitivity for imaging of the interior portion of the brain. The fan-beam collimator would provide lower resolution but complete sampling of the brain addressing data sufficiency and allowing a volume-of-interest to be defined over the occipital lobe for calculation of SBR's. Herein we focus on the design of the MPH component of the combined system. Combined reconstruction will be addressed in a subsequent publication. An analysis of 46 clinical DaTscan studies was performed to provide information to define the VOI, and design of a MPH collimator to image this VOI. The system spatial resolution for the MPH was set to 4.7 mm, which is comparable to that of clinical PET systems, and significantly smaller than that of fan-beam collimators employed in SPECT. With this set, we compared system sensitivities for three aperture array designs, and selected the 3 × 3 array due to it being the highest of the three. The combined sensitivity of the apertures for it was similar to that of an ultra-high resolution fan-beam (LEUHRF) collimator, but smaller than that of a high-resolution fan-beam collimator (LEHRF). On the basis of these results we propose the further exploration of this design through simulations, and the development of combined MPH and fan-beam reconstruction.

Modeling the respiratory motion of solitary pulmonary nodules and determining the impact of respiratory motion on their detection in SPECT imaging

The objectives of this investigation were to model the respiratory motion of solitary pulmonary nodules (SPN) and then use this model to determine the impact of respiratory motion on the localization and detection of small SPN in SPECT imaging for four reconstruction strategies. The respiratory motion of SPN was based on that of normal anatomic structures in the lungs determined from breath-held CT images of a volunteer acquired at two different stages of respiration. End-expiration (EE) and time-averaged (Frame Av) non-uniform-B-spline cardiac torso (NCAT) digital-anthropomorphic phantoms were created using this information for respiratory motion within the lungs. SPN were represented as 1 cm diameter spheres which underwent linear motion during respiration between the EE and end-inspiration (EI) time points. The SIMIND Monte Carlo program was used to produce SPECT projection data simulating Tc-99m depreotide (NeoTect) imaging. The projections were reconstructed using 1) no correction (NC), 2) attenuation correction (AC), 3) resolution compensation (RC), and 4) attenuation correction, scatter correction, and resolution compensation (AC_SC_RC). A human-observer localization receiver operating characteristics (LROC) study was then performed to determine the difference in localization and detection accuracy with and without the presence of respiratory motion. The LROC comparison determined that respiratory motion degrades tumor detection for all four reconstruction strategies, thus correction for SPN motion would be expected to improve detection accuracy. The inclusion of RC in reconstruction improved detection accuracy for both EE and Frame Av over NC and AC. Also the magnitude of the impact of motion was least for AC_SC_RC.

LROC Investigation of Three Strategies for Reducing the Impact of Respiratory Motion on the Detection of Solitary Pulmonary Nodules in SPECT

The objective of this investigation was to determine the effectiveness of three motion reducing strategies in diminishing the degrading impact of respiratory motion on the detection of small solitary pulmonary nodules (SPN) in single photon emission computed tomographic (SPECT) imaging in comparison to a standard clinical acquisition and the ideal case of imaging in the absence of respiratory motion. To do this non-uniform rational B-spline cardiac-torso (NCAT) phantoms based on human-volunteer CT studies were generated spanning the respiratory cycle for a normal background distribution of Tc-99m NeoTect. Similarly, spherical phantoms of 1.0 cm diameter were generated to model small SPN for each of 150 uniquely located sites within the lungs whose respiratory motion was based on the motion of normal structures in the volunteer CT studies. The SIMIND Monte Carlo program was used to produce SPECT projection data from these. Normal and single-lesion containing SPECT projection sets with a clinically realistic Poisson noise level were created for the cases of: 1) the end-expiration (EE) frame with all counts, 2) respiration-averaged motion with all counts, 3) one-fourth of the 32 frames centered around EE (Quarter-Binning), 4) one-half of the 32 frames centered around EE (Half-Binning), and 5) eight temporally binned frames spanning the respiratory cycle. Each of the sets of combined projection data were reconstructed with RBI-EM with system spatial-resolution compensation (RC). Based on the known motion for each of the 150 different lesions, the reconstructed volumes of respiratory bins were shifted so as to superimpose the locations of the SPN onto that in the first bin (Reconstruct and Shift). Five human-observers performed localization receiver operating characteristics (LROC) studies of SPN detection. The observer results were analyzed for statistical significance differences in SPN detection accuracy among the three correction strategies, the standard acquisition, and the ideal case of the absence of respiratory motion. Our human-observer LROC determined that Quarter-Binning and Half-Binning strategies resulted in SPN detection accuracy statistically significantly below (P < 0.05) that of standard clinical acquisition, whereas the Reconstruct and Shift strategy resulted in a detection accuracy not statistically significantly different from that of the ideal case. This investigation demonstrates that tumor detection based on acquisitions associated with less than all the counts which could potentially be employed may result in poorer detection despite limiting the motion of the lesion. The Reconstruct and Shift method results in tumor detection that is equivalent to ideal motion correction.

The effect of elbow hyperextension on ball speed in cricket fast bowling

This study investigates how elbow hyperextension affects ball release speed in fast bowling. A two-segment planar computer simulation model comprising an upper arm and forearm + hand was customised to an elite fast bowler. A constant torque was applied at the shoulder and elbow hyperextension was represented using a damped linear torsional spring at the elbow. The magnitude of the constant shoulder torque and the torsional spring parameters were determined by concurrently matching three performances. Close agreement was found between the simulations and the performances with an average difference of 3.8%. The simulation model with these parameter values was then evaluated using one additional performance. Optimising ball speed by varying the torsional spring parameters found that elbow hyperextension increased ball release speed. Perturbing the elbow torsional spring stiffness indicated that the increase in ball release speed was governed by the magnitude of peak elbow hyperextension and the amount that the elbow recoils back towards a straight arm after reaching peak elbow hyperextension. This finding provides a clear understanding that a bowler who hyperextends at the elbow and recoils optimally will have an increase in ball speed compared to a similar bowler who cannot hyperextend. A fast bowler with 20° of elbow hyperextension and an optimal level of recoil will have increased ball speeds of around 5% over a bowler without hyperextension.