Browsing by Subject "XCAT"

Virtual imaging trials (VITs) are a growing part of medical imaging research. VITs are a powerful alternative to the current gold-standard for determining or verifying the efficacy of new technology in healthcare: the clinical trial. Prohibitively high expenses, multi-site standardization of protocols, and risks to the health of the trial’s patient population are all challenges associated with the clinical trial; conversely, these challenges highlight the strengths of virtualization, particularly with regard to evaluating medical imaging technologies.Virtual imaging requires a combination of virtual subjects, physics-based imaging simulation platforms, and virtual pathologies. Currently, most computational phantom organs and pathologies are segmented or generated from clinical CT images. With this approach, most computational organs and pathologies are necessarily static, comprising only a single instantaneous representation. Further, this static-anatomy–static-pathology approach does not address the underlying physiological constraints acting on the organs or their pathologies—making some imaging exams (e.g., perfusion, coronary angiography) difficult to simulate robustly. It also does not provide a clear path toward including anatomical and physiological (functional) detail at sub-CT resolution. This project aims to integrate high-resolution, dynamic features into computational human models. The focus is primarily an advanced model known as XCAT. These additions include healthy and progressive-disease anatomy and physiology, micron-level–resolution coronary artery lesions, and an array of pathologies. In particular, we focus on the physiology needed for CT perfusion studies, dynamic lesions, or coronary artery disease (CAD), and means to integrate each of these features into XCAT via custom software. The outcome is further to demonstrate the utility of each of these advances with representative simulated imaging. Chapter 1 presents a method using clinical information and physiological theory to develop a mathematical model that produces the liver vasculature within a given XCAT. The model can be used to simulate contrast perfusion by taking into account contrast position and concentration at an initial time t and the spatial extent of the contrast in the liver vasculature at subsequent times. The mathematical method enables the simulation of hepatic contrast perfusion in the presence or absence of abnormalities (e.g., focal or diffuse disease) for arbitrary imaging protocols, contrast concentrations, and virtual patient body habitus. The vessel growing method further generalizes to vascular models of other organs as it is based on a parameterized approach, allowing for flexible repurposing of the developed tool. Chapter 2 presents a method for using cardiac plaque histology and morphology data acquired at micron-level resolution to generate new, novel plaques informed by a large, original patient cohort. A methodology for curating and validating the anatomical and physiological realism was further applied to the synthesized plaques to ensure realism. This method was integrated with the XCAT heart and coronary artery models to allow simulated imaging of a wide variety of coronary artery plaques in varied orientations and with unique material distribution and composition. Generation of 200 unique plaques has been optimized to take as little as 5 seconds with GPU acceleration. This work enables future studies to optimize current and emerging CT imaging methods used to detect, diagnose, and treat coronary artery disease. Chapter 3 focuses on small-scale modeling of the internal structure of the bones of the chest. The internal structure of the bones appears as a diffuse but recognizable texture under medical imaging and corresponds to a complex physical structure tuned to meet the physical purpose of the bone (e.g., weight-bearing, protective structure, etc.). The project aimed to address the limitations of prior texture-based modelling by creating mathematically based fine bone structures. The method was used to generate realistic bone structures, defined as polygon meshes, with accurate morphological and topological detail for 45 chest bones for each XCAT phantom. This new method defines the spatial extent of the complementary bone–marrow structures that are the root cause of the characteristic image texture 1-4 and provides a transition from using image-informed characteristic power law textures to a ground-truth model with exact morphology—which we additionally paired with the DukeSim CT simulator5 and XCAT phantoms6 to produce radiography and CT images with physics-based bone textures. This work enables CT acquisition parameter optimization studies that can inform clinical image assessment of osteoporosis and bone fractures. Chapter 4 proposes a new model of lesion morphology and insertion and was created with the intent to be informed and validated by—rather than constrained by—imaging data. It additionally includes the new incorporation of biological data, intended to provide dynamic computational lung lesion models for use in CT simulation applications. Each chapter includes a section presenting an example application of the respective tools in virtual medical imaging. Chapter 5 concludes this work with a brief summary of the content and is followed by Appendices A–D. The appendices are organized by topic and contain a visual demonstration of the work in a series of high-resolution, full-page images.

Purpose

Materials and methods

Results

Conclusions

Computational phantoms are set to play an important role in imaging research. As medicine moves increasingly towards providing individualized, patient-specific care, it is imperative that simulations be completed on patient-specific anatomy, rather than a reference standard. To that end, there is need for a variety of realistic phantoms for clinical studies.

This work adds to the existing extended cardiac and torso (XCAT) adult phantom series (two phantoms based on visual human data) by building new models based on adult patient computed tomography (CT) image data. These CT datasets were obtained from Duke University's patient CT database.

Each image-set was segmented using in-house segmentation software, defining bony structures and large organs within the field of view. 3D non-uniform rational b-spline (NURBS) surfaces were fitted to the segmented data. Using the multi-channel large diffeomorphic deformation metric mapping (MC-LDDMM) network, a transform was calculated to morph an existing XCAT model to the segmented patient geometry. Fifty-eight adult XCAT models were added to the phantom library.

In addition to the expanding the XCAT library, the feasibility of incorporating texture was investigated. Currently, the XCAT phantom structures are assumed to be homogeneous. This can lead to unrealistic appearance when the phantoms are combined with imaging simulations, particularly in CT. The purpose of this project was to capture anatomical texture and test it in a simulated phantom. Image data from the aforementioned patient CT database served as the source of anatomical texture.

The images were de-noised using anisotropic diffusion. Next, several regions of interest (ROIs) were taken from the liver and lungs of CT images. Using the ROIs as a source of texture, a larger stochastic texture image-set was created using the Image Quilting algorithm.

The visual human adult male XCAT phantom was voxelized at the same resolution as the texture image. The voxels inside the liver were directly replaced by the corresponding voxels of texture. Similarly for the lung, the voxels between the existing lung bronchi/blood vessels and the lung wall were replaced by texture voxels. This procedure was performed using ten different patient CT image-sets as sources of texture.

To validate the similarity of the artificial textures to the source textures, reconstructions of the adult male XCAT phantom with added textures were compared to the clinical images via receiver operator characteristic (ROC) analysis, a two-sample t-test, equivalence test, and through comparing absolute differences between scores.

It was concluded that this framework provides a valuable tool in which anatomical texture can be incorporated into computational phantoms. It is anticipated that this step towards making many anatomically variable virtual models indicative of a patient populace and making these models more realistic will be useful in medical imaging research, especially for studies relating to image quality.

To date, image localization of mobile tumors prior to radiation delivery has primarily been confined to 2D and 3D technologies, such as fluoroscopy and 3D cone-beam CT (3D-CBCT). Due to the limited information from these images, larger volumes of healthy tissue are often irradiated in order to ensure the radiation field encompasses the entirety of the target motion. Since the overarching goal of radiation therapy is to deliver maximum dose to cancerous cells and simultaneously minimize the radiation delivered to healthy surrounding tissues, it would be ideal to use 4D imaging to obtain time-resolved volume images of the tumor motion during respiration.

4D-CBCT imaging has been previously investigated, but has not yet seen large clinical translation due to the obstacles of long acquisition time and large image radiation dose. Furthermore, 4D-CBCT currently requires the use of external surrogates to correlate the patient's respiration with the image acquisition process. This correlation has been under question by a multitude of studies demonstrating the uncertainties that exist between the surrogate and the actual motion of the internal anatomy. Errors in the correlation process may result in image artifacts, which could potentially lead to reconstructions with inaccurate target volumes, thereby defeating the purpose of even using 4D-CBCT.

It is therefore the aim of this dissertation to initially highlight an additional limitation of using 3D-CBCT for imaging respiratory motion and thereby reiterate the need for 4D-CBCT imaging in the treatment room, develop a simple and efficient technique to achieve markerless, self-sorted 4D-CBCT and finally to comprehensively evaluate its robustness across a variety of potential clinical scenarios with a digital human phantom.

People often spend a longer period of time exhaling as compared with inhaling, and some do so in an extremely disproportionate manner. To demonstrate the disadvantage of using 3D-CBCT in such instances, a dynamic thorax phantom was imaged with a large variety of simulated and patient-derived respiratory traces of ratios of time spent in the inspiration phase versus time spent in the expiration phase (I/E ratio). Canny edge detection and contrast measures were employed to compare the internal target volumes (ITVs) generated per profile. The results revealed that an I/E ratio of less than one can lead to potential underestimation of the ITV with the severity increasing as the inspiration becomes more disproportionate to the expiration. This occurs because of the loss of contrast in the inspiration phase, due to the fewer number of projections acquired there. The measured contrast reduction was as high as 94% for small targets (0.5 cm) moving large amplitudes (2.0 cm) and still as much as 22.3% for large targets (3.0 cm) moving small amplitudes (0.5 cm). This is alarming because the degraded visibility of the target in the inspiration phase may inaccurately impact the alignment of the planning ITV with that of the FB-CBCT and thereby affect the accuracy of the localization and consequent radiation delivery. These potential errors can be avoided with the use of 4D-CBCT instead, to form the composite volume and serve as the verification ITV for alignment.

In order to delineate accurate target volumes from 4D-CBCT phase images, it is crucial that the projections be properly associated with the patient's respiration. Thus, in order to improve previously developed 4D-CBCT techniques, the basics of Fourier Transform (FT) theory were utilized to extract the respiratory signal directly from the acquired projection data. Markerless, self-sorted 4D-CBCT reconstruction was achieved by developing methods based on the phase and magnitude information of the Fourier Transform. Their performance was subsequently compared to the gold standard of visual identification of peak-inspiration projections. Slow-gantry acquired projections of two sets of physical phantom data with sinusoidal respiratory cycles of 3 and 6 seconds as well as three patients were used as initial evaluation of the feasibility of the Fourier technique. Quantitative criteria consisted of average difference in respiratory phase (ADRP) and percentage of projections assigned within 10% respiratory phase of the gold standard (PP10). For all five projection datasets, the results supported feasibility of both FT-Phase and FT-Magnitude methods with ADRP values less than 5.3% and PP10 values of 87.3% and above.

Because the technique proved to be promising in the initial feasibility study, a more comprehensive evaluation was necessary in order to assess the robustness of the technique across a larger set of possibilities that may be encountered in the clinic. A 4D digital XCAT phantom was used to generate an array of respiratory and anatomical variables that affect the performance of the technique. The respiratory variables studied included: inspiration to expiration ratio, respiratory cycle length, diaphragmatic motion amplitude, AP chest wall expansion amplitude, breathing irregularities such as baseline shift and inconsistent peak-inspiration amplitude, as well as six breathing profiles derived from cine-MRI images of three healthy volunteers and three lung cancer patients. The anatomical variables studied included: male and female patient size (physical dimension and adipose content), body-mass-index (BMI) category, tumor location, and percentage of the lung in the field-of-view (FOV) of the projection data. CBCT projections of each XCAT phantom were then generated. Additional external imaging factors such as image noise and detector wobble were added to select cases with different percentages of lung in the projection FOV to investigate any effects on the robustness. FT-Phase and FT-Magnitude were each applied and quantitatively compared to the gold standard. Both methods proved to be robust across the studied scenarios with ADRP<10% and PP10>90%, when incorporating minor modifications to region-of-interest (ROI) selection and/or low-frequency location to certain cases of diaphragm amplitude and lung percentage in the FOV of the projection (for which a method may have previously struggled). Nevertheless, in the instance where one method initially faltered, the other method prevailed and successfully identified peak-inspiration projections. This is promising because it suggests that the two methods provide complementary information to each other. To ensure appropriate clinical adaptation of markerless, self-sorted 4D-CBCT, perhaps an optimal integration of the two methods can be developed.

Prospective estimation of patient CT organ dose prior to examination can help technologist adjust CT scan settings to reduce radiation dose to patient while maintaining certain image quality. One possible way to achieve this is matching patient to digital models precisely. In previous work, patient matching was performed manually by matching the trunk height which was defined as the distance from top of clavicle to bottom of pelvis. However, this matching method is time consuming and impractical in scout images where entire trunk is not included. Purpose of this work was to develop an automatic patient matching strategy and verify its accuracy.