Cone-beam CT for imaging of the head/brain: Development and assessment of scanner prototype and reconstruction algorithms

PURPOSE

Our aim was to develop a high-quality, mobile cone-beam computed tomography (CBCT) scanner for point-of-care detection and monitoring of low-contrast, soft-tissue abnormalities in the head/brain, such as acute intracranial hemorrhage (ICH). This work presents an integrated framework of hardware and algorithmic advances for improving soft-tissue contrast resolution and evaluation of its technical performance with human subjects.

METHODS

Four configurations of a CBCT scanner prototype were designed and implemented to investigate key aspects of hardware (including system geometry, antiscatter grid, bowtie filter) and technique protocols. An integrated software pipeline (c.f., a serial cascade of algorithms) was developed for artifact correction (image lag, glare, beam hardening and x-ray scatter), motion compensation, and three-dimensional image (3D) reconstruction [penalized weighted least squares (PWLS), with a hardware-specific statistical noise model]. The PWLS method was extended in this work to accommodate multiple, independently moving regions with different resolution (to address both motion compensation and image truncation). Imaging performance was evaluated quantitatively and qualitatively with 41 human subjects in the neurosciences critical care unit (NCCU) at our institution.

RESULTS

The progression of four scanner configurations exhibited systematic improvement in the quality of raw data by variations in system geometry (source-detector distance), antiscatter grid, and bowtie filter. Quantitative assessment of CBCT images in 41 subjects demonstrated: ~70% reduction in image nonuniformity with artifact correction methods (lag, glare, beam hardening, and scatter); ~40% reduction in motion-induced streak artifacts via the multi-motion compensation method; and ~15% improvement in soft-tissue contrast-to-noise ratio (CNR) for PWLS compared to filtered backprojection (FBP) at matched resolution. Each of these components was important to improve contrast resolution for point-of-care cranial imaging.

CONCLUSIONS

This work presents the first application of a high-quality, point-of-care CBCT system for imaging of the head/ brain in a neurological critical care setting. Hardware configuration iterations and an integrated software pipeline for artifacts correction and PWLS reconstruction mitigated artifacts and noise to achieve image quality that could be valuable for point-of-care detection and monitoring of a variety of intracranial abnormalities, including ICH and hydrocephalus.

Reconstruction-of-difference (RoD) imaging for cone-beam CT neuro-angiography

Timely evaluation of neurovasculature via CT angiography (CTA) is critical to the detection of pathology such as ischemic stroke. Cone-beam CTA (CBCT-A) systems provide potential advantages in the timely use at the point-of-care, although challenges of a relatively slow gantry rotation speed introduce tradeoffs among image quality, data consistency and data sparsity. This work describes and evaluates a new reconstruction-of-difference (RoD) approach that is robust to such challenges. A fast digital simulation framework was developed to test the performance of the RoD over standard reference reconstruction methods such as filtered back-projection (FBP) and penalized likelihood (PL) over a broad range of imaging conditions, grouped into three scenarios to test the trade-off between data consistency, data sparsity and peak contrast. Two experiments were also conducted using a CBCT prototype and an anthropomorphic neurovascular phantom to test the simulation findings in real data. Performance was evaluated primarily in terms of normalized root mean square error (NRMSE) in comparison to truth, with reconstruction parameters chosen to optimize performance in each case to ensure fair comparison. The RoD approach reduced NRMSE in reconstructed images by up to 50%-53% compared to FBP and up to 29%-31% compared to PL for each scenario. Scan protocols well suited to the RoD approach were identified that balance tradeoffs among data consistency, sparsity and peak contrast-for example, a CBCT-A scan with 128 projections acquired in 8.5 s over a 180°  +  fan angle half-scan for a time attenuation curve with ~8.5 s time-to-peak and 600 HU peak contrast. With imaging conditions such as the simulation scenarios of fixed data sparsity (i.e. varying levels of data consistency and peak contrast), the experiments confirmed the reduction of NRMSE by 34% and 17% compared to FBP and PL, respectively. The RoD approach demonstrated superior performance in 3D angiography compared to FBP and PL in all simulation and physical experiments, suggesting the possibility of CBCT-A on low-cost, mobile imaging platforms suitable to the point-of-care. The algorithm demonstrated accurate reconstruction with a high degree of robustness against data sparsity and inconsistency.

Assessment of image quality in soft tissue and bone visualization tasks for a dedicated extremity cone-beam CT system

OBJECTIVE

To assess visualization tasks using cone-beam CT (CBCT) compared to multi-detector CT (MDCT) for musculoskeletal extremity imaging.

METHODS

Ten cadaveric hands and ten knees were examined using a dedicated CBCT prototype and a clinical multi-detector CT using nominal protocols (80 kVp-108mAs for CBCT; 120 kVp- 300 mAs for MDCT). Soft tissue and bone visualization tasks were assessed by four radiologists using five-point satisfaction (for CBCT and MDCT individually) and five-point preference (side-by-side CBCT versus MDCT image quality comparison) rating tests. Ratings were analyzed using Kruskal-Wallis and Wilcoxon signed-rank tests, and observer agreement was assessed using the Kappa-statistic.

RESULTS

Knee CBCT images were rated "excellent" or "good" (median scores 5 and 4) for "bone" and "soft tissue" visualization tasks. Hand CBCT images were rated "excellent" or "adequate" (median scores 5 and 3) for "bone" and "soft tissue" visualization tasks. Preference tests rated CBCT equivalent or superior to MDCT for bone visualization and favoured the MDCT for soft tissue visualization tasks. Intraobserver agreement for CBCT satisfaction tests was fair to almost perfect (κ ~ 0.26-0.92), and interobserver agreement was fair to moderate (κ ~ 0.27-0.54).

CONCLUSION

CBCT provided excellent image quality for bone visualization and adequate image quality for soft tissue visualization tasks.

KEY POINTS

• CBCT provided adequate image quality for diagnostic tasks in extremity imaging. • CBCT images were "excellent" for "bone" and "good/adequate" for "soft tissue" visualization tasks. • CBCT image quality was equivalent/superior to MDCT for bone visualization tasks.

Environmental influences on DNA superhelicity. The effect of ionic strength on superhelix conformation in solution

The techniques of small-angle X-ray scattering and analysis that have been developed by the authors are used to investigate the influence of ionic strength on the superhelical conformation of native COP608 plasmid DNA in solution. For salt concentrations below 0.1 M, the superhelicity is partitioned between twisting (Tw) and writhing (Wr) in the ratio delta Tw/Wr = 2. Near the physiological salt concentration, [Na+] = 0.2 M, a co-operative transition is observed in which the pitch angle of the toroidal superhelix is drastically decreased. This results in an almost complete relaxation of writhe. At salt concentrations in excess of the threshold for this transition, the superhelical partitioning occurs in the ratio delta Tw/Wr greater than 25. Energetic considerations support the suggestion that this transition results from co-operative, superhelical B to Z transconformation reactions at susceptible sites. A method is discussed that will enable the direct measurement of this secondary structural transition by means of X-ray scattering.

The relationship of personal financial status to the utilization of community mental health centers in rural Appalachia

As a follow-up to an aggregate study of the relationship of economic factors to the utilization of mental health facilities, this study, using individual data, attempted to determine the associative strengths of income factors--welfare and unemployment--for utilization of community mental health centers (CMHCs) in rural Appalachia. On the basis of the earlier study and of previous studies of social class and utilization of CMHCs it was hypothesized that for this sample of 151 clients of eight CMHCs in Ohio and West Virginia, unemployment and welfare factors would be most strongly associated with utilization. A multiple regression analysis indicated that when compared to other independent variables, such as life satisfaction, demographic, and personal factors, receipt of food stamps was the most important factor in relating to utilization; this relationship was considerably stronger when the more rural areas were separated for analysis. Some relationship between employment status and utilization was also found. The results are discussed in terms of unique patterns of social service dependency in more rural Appalachia.

X-ray scattering from the superhelix in circular DNA

This communication presents measurements, made with a newly constructed position-sensitive detector, of the small-angle x-ray scattering from the first-order superhelix of native COP608 plasmid DNA. This instrument measures intensities free of slit effects and provides good resolution in the region of interest. The reported observations, made both in the presence and in the absence of intercalator, closely fit the scattering patterns calculated for noninterwound helical first-order superhelices. These results are consistent with a toroidal helical structure but not with interwound conformations. The pitch angle alpha and contour length per turn c are reported for the native molecule at several concentrations of the platinum intercalating compound. From these parameters, the best-fitting toroidal helix is constructed and its geometry is investigated. The specific linking difference of the native molecule is estimated to be delta Lk/Lk0 approximately equal to -0.055. If the best-fitting toroidal helix is taken to be the actual structure, the partitioning of superhelicity between twist and writhe occurs in the approximate ratio of 2:1.

Economic indicators of mental health service utilization in rural Appalachia

This exploratory study examined the relative predictive strengths of selected economic factors (welfare cases, banking activity, unemployment, retail sales, motor vehicle sales) for utilization of mental health services (hotline calls, intake at community mental health centers and admissions at mental hospitals) over a 78-month period in rural Appalachia. Monthly data were tested for autocorrelation and adjusted for seasonality and inflation. Regression analyses indicated that (a) economic factors did account for a considerable portion of variance in mental health factors; (b) these factors predicted mental hospital admissions and hotline calls; (c) strengths of these relationships were quite consistent across the areas sampled, but the directions sometimes were different; (d) welfare factors were the best predictors of utilization; (e) Aid to Families with Dependent Children was generally the best single predictor of utilization, especially when mental health factors were lagged by 3 months. A causative model describing the decision-making process involved in the utilization of mental health services was presented.