Low-dose imaging of liver diseases through neutron stimulated emission computed tomography: Simulations in GEANT4
Neutron stimulated emission computed tomography (NSECT) is a non-invasive, tomographic imaging technique with the ability to locate and quantify elemental concentration in a tissue sample. Previous studies have shown that NSECT has the ability to differentiate between benign and malignant tissue and diagnose liver iron overload while using a neutron beam tomographic acquisition protocol followed by iterative image reconstruction. These studies have shown that moderate concentrations of iron can be detected in the liver with moderate dose levels and long scan times. However, a low-dose, reduced scan time technique to differentiate various liver diseases has not been tested. As with other imaging modalities, the performance of NSECT in detecting different diseases while reducing dose and scan time will depend on the acquisition techniques and parameters that are used to scan the patients. In order to optimize a clinical liver imaging system based on NSECT, it is important to implement low-dose techniques and evaluate their feasibility, sensitivity, specificity and accuracy by analyzing the generated liver images from a patient population. This research work proposes to use Monte-Carlo simulations to optimize a clinical NSECT system for detection, localization, quantification and classification of liver diseases. This project has been divided into three parts; (a) implement two novel acquisition techniques for dose reduction, (b) modify MLEM iterative image reconstruction algorithm to incorporate the new acquisition techniques and (c) evaluate the performance of this combined technique on a simulated patient population.
The two dose-reduction, acquisition techniques that have been implemented are; (i) use of a single angle scanning, multi-detector acquisition system and (ii) the neutron-time resolved imaging (n-TRI) technique. In n-TRI, the NSECT signal has been resolved in time by a function of the speed of the incident neutron beam and this information has been used to locate the liver lesions in the tissue. These changes in the acquisition system have been incorporated and used to modify MLEM iterative image reconstruction algorithm to generate liver images. The liver images are generated from sinograms acquired by the simulated n-TRI based NSECT scanner from a simulated patient population.
The simulated patient population has patients of different sizes, with different liver diseases, multiple lesions with different sizes and locations in the liver. The NSECT images generated from this population have been used to validate the liver imaging system developed in this project. Statistical tests such as ROC and student t-tests have been used to evaluate this system. The overall improvement in dose and scan time as compared to the NSECT tomographic system have been calculated to verify the improvement in the imaging system. The patient dose was calculated by measuring the energy deposited by the neutron beam in the liver and surrounding body tissue. The scan time was calculated by measuring the time required by a neutron source to produce the neutron fluence required to generate a clinically viable NSECT image.
Simulation studies indicate that this NSECT system can detect, locate, quantify and classify liver lesions in different sized patients. The n-TRI imaging technique can detect lesions with wet iron concentration of 0.5 mg/g or higher in liver tissue in patients with 30 cm torso and can quantify lesions at 0.3 ns timing resolution with errors ≤ 17.8%. The NSECT system can localize and classify liver lesions of hemochromatosis, hepatocellular carcinoma, fatty liver tissue and cirrhotic liver tissue based on bulk and trace element concentrations. In a small patient with a torso major axis of 30 cm, the n-TRI based liver imaging technique can localize 91.67% of all lesions and classify lesions with an accuracy of 88.23%. The dose to the small patient is 0.37 mSv a reduction of 39.9% as compared to the NSECT tomographic system and scan times are comparable to that of an abdominal MRI scan. In a bigger patient with a torso major axis of 50cm, the n-TRI based technique can detect 75% of the lesions, while localizing 66.67% of the lesions, the accuracy of classification is 76.47%. The effective dose equivalent delivered to the larger patient is 1.57 mSv for a 68.8% decrease in dose as compared to a tomographic NSECT system.
The research performed for this dissertation has two important outcomes. First, it demonstrates that NSECT has the clinical potential for detection, localization and classification of liver diseases in patients. Second, it provides a validation of the simulation of a novel low-dose liver imaging technique which can be used to guide future development and experimental implementation of the technique.
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