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Biomedical subjects

K L Lam

Publications and source records attributed to K L Lam.

At least 19 recordsLinked to original sources
PubMed2001

Technical note: acquisition of CT models for radiotherapy applications with reduced tube heating.

The potential or changing computed tomography (CT) protocols to provide data sets that generate high quality digitally reconstructed radiographs (DRRs) from scans with very low tube currents is demonstrated. DRRs were generated from CT data acquired with slice thickness of 1, 3, and 5 mm, using high current to reduce noise in axial images. These DRRs were compared to one generated from a CT scan acquired using 1 mm aperture and very low (10 mA) current. The DRR generated via this technique is comparable to that generated with high current and 1 mm aperture, and higher resolution than from the 3 and 5 mm CT scans.

Humans↗
PubMed2001

A feasibility study of mutual information based setup error estimation for radiotherapy.

We have investigated a fully automatic setup error estimation method that aligns DRRs (digitally reconstructed radiographs) from a three-dimensional planning computed tomography image onto two-dimensional radiographs that are acquired in a treatment room. We have chosen a MI (mutual information)-based image registration method, hoping for robustness to intensity differences between the DRRs and the radiographs. The MI-based estimator is fully automatic since it is based on the image intensity values without segmentation. Using 10 repeated scans of an anthropomorphic chest phantom in one position and two single scans in two different positions, we evaluated the performance of the proposed method and a correlation-based method against the setup error determined by fiducial marker-based method. The mean differences between the proposed method and the fiducial marker-based method were smaller than 1 mm for translational parameters and 0.8 degree for rotational parameters. The standard deviations of estimates from the proposed method due to detector noise were smaller than 0.3 mm and 0.07 degree for the translational parameters and rotational parameters, respectively.

Algorithms↗
PubMed2000

Genetic analysis of the CYP2D6 locus in a Hong Kong Chinese population.

BACKGROUND: The cytochrome P450 CYP2D6 enzyme debrisoquine 4-hydroxylase metabolizes many different classes of commonly used drugs, such as tricyclic antidepressants and neuroleptics. Genetic polymorphism of the CYP2D6 gene is responsible for pronounced interindividual and interracial differences in the metabolism of these drugs. The CYP2D6*10 allele and its variants are the most frequent alleles found in Orientals, and they are responsible for diminished debrisoquine 4-hydroxylase activity because of the presence of a C(188)-->T mutation in exon 1. METHODS: One hundred nineteen Hong Kong Chinese subjects were genotyped by means of allele-specific PCR, PCR, and restriction enzyme analysis for 10 CYP2D6 alleles (CYP2D6*1, *2, *4D, *5, *8/*14, *10A, *10B, *15, *16, and J9). RESULTS: CYP2D6*10B was the most prevalent allele, and CYP2D6*10/CYP2D6*10 was the most frequent genotype, representing 41.17% [corrected] of the population. CONCLUSIONS: There was no significant difference in the prevalence of the alleles analyzed between our study and the Chinese populations genotyped previously. This is the largest study in terms of the number of CYP2D6 alleles analyzed in an Oriental population and the first one conducted in a Hong Kong Chinese population.

Alleles↗
PubMed1999

Relative dosimetry using active matrix flat-panel imager (AMFPI) technology.

The first examination of the use of active matrix flat-panel arrays for dosimetry in radiotherapy is reported. Such arrays are under widespread development for diagnostic and radiotherapy imaging. In the current study, an array consisting of 512 x 512 pixels with a pixel pitch of 508 microm giving an area of 26 x 26 cm2 has been used. Each pixel consists of a light sensitive amorphous silicon (a-Si:H) photodiode coupled to an a-Si:H thin-film transistor. Data was obtained from the array using a dedicated electronics system allowing real-time data acquisition. In order to examine the potential of such arrays as quality assurance devices for radiotherapy beams, field profile data at photon energies of 6 and 15 MV were obtained as a function of field size and thickness of overlying absorbing material (solid water). Two detection configurations using the array were considered: a configuration (similar to the imaging configuration) in which an overlying phosphor screen is used to convert incident radiation to visible light photons which are detected by the photodiodes; and a configuration without the screen where radiation is directly sensed by the photodiodes. Compared to relative dosimetry data obtained with an ion chamber, data taken using the former configuration exhibited significant differences whereas data obtained using the latter configuration was generally found to be in close agreement. Basic signal properties, which are pertinent to dosimetry, have been investigated through measurements of individual pixel response for fluoroscopic and radiographic array operation. For signal levels acquired within the first 25% of pixel charge capacity, the degree of linear response with dose was found to be better than 99%. The independence of signal on dose rate was demonstrated by means of stability of pixel response over the range of dose rates allowed by the radiation source (80-400 MU/min). Finally, excellent long-term stability in pixel response, extending over a 2 month period, was observed.

Biophysical Phenomena↗
PubMed1999

A mathematical model for correcting patient setup errors using a tilt and roll device.

An algorithm is presented for determining how to adjust the actuators of a tilt and roll table. The algorithm is based on a geometrical model of the table, which was designed with six degrees of freedom. This design and algorithm allows complete translational and rotational corrections to be applied to the target volume position on a daily basis.

Algorithms↗
PubMed1998

Improvement of CT-based treatment-planning models of abdominal targets using static exhale imaging.

PURPOSE: CT-based models of the patient that do not account for the motion of ventilation may not accurately predict the shape and position of critical abdominal structures. Respiratory gating technology for imaging and treatment is not yet widely available. The purpose of the current study is to explore an intermediate step to improve the veracity of the patient model and reduce the treated volume by acquiring the CT data with the patients holding their breath at normal exhale. METHODS AND MATERIALS: The ventilatory time courses of diaphragm movement for 15 patients (with no special breathing instructions) were measured using digitized movies from the fluoroscope during simulation. A subsequent clinical protocol was developed for treatment based on exhale CT models. CT scans (typically 3.5-mm slice thickness) were acquired at normal exhale using a spiral scanner. The scan volume was divided into two to three segments, to allow the patient to breathe in between. Margins were placed about intrahepatic target volumes based on the ventilatory excursion inferior to the target, and on only the reproducibility of exhale position superior to the target. RESULTS: The average patient's diaphragm remained within 25% of the range of ventilatory excursion from the average exhale position for 42% of the typical breathing cycle, and within 25% of the range from the average inhale position for 15% of the cycle. The reproducibility of exhale position over multiple breathing cycles was 0.9 mm (2sigma), as opposed to 2.6 mm for inhale. Combining the variation of exhale position and the uncertainty in diaphragm position from CT slices led to typical margins of 10 mm superior to the target, and 19 mm inferior to the target, compared to margins of 19 mm in both directions under our prior protocol of margins based on free-breathing CT studies. For a typical intrahepatic target, these smaller volumes resulted in a 3.6% reduction in Veff for the liver. Analysis of portal films shows proper target coverage for patients treated based on exhale modeled plans. CONCLUSIONS: Modeling abdominal treatments at exhale, while not realizing all the gains of gated treatments, provides an immediate reduction in the volume of normal tissue treated, and improved reliability of patient data for NTCP modeling, when compared to current "free breathing" CT models of patients.

Diaphragm↗
PubMed1998

Measurement of backscatter to the monitor chamber of medical accelerators using target charge.

A simple noninvasive method is described for determining the backscatter to a monitor chamber of a medical accelerator based on the measurement of charge deposited in the target. This method is compared quantitatively to the more elaborate telescopic method for photon beams of 6 MV and 15 MV on linear accelerators having mica and Kapton monitor chambers. The new target charge method gives results consistent with the telescopic method to within 0.3%.

Equipment Design↗
PubMed1998

A tilt and roll device for automated correction of rotational setup errors.

A tilt and roll device has been developed to add two additional degrees of freedom to an existing treatment table. This device allows computer-controlled rotational motion about the inferior-superior and left-right patient axes. The tilt and roll device comprises three supports between the tabletop and base. An automotive type universal joint welded to the end of a steel pipe supports the center of the table. Two computer-controlled linear electric actuators utilizing high accuracy stepping motors support the foot of table and control the tilt and roll of the tabletop. The current system meets or exceeds all pre-design specifications for precision, weight capacity, rigidity, and range of motion.

Biophysical Phenomena↗
PubMed1998

Computerized analysis of mammographic microcalcifications in morphological and texture feature spaces.

We are developing computerized feature extraction and classification methods to analyze malignant and benign microcalcifications on digitized mammograms. Morphological features that described the size, contrast, and shape of microcalcifications and their variations within a cluster were designed to characterize microcalcifications segmented from the mammographic background. Texture features were derived from the spatial gray-level dependence (SGLD) matrices constructed at multiple distances and directions from tissue regions containing microcalcifications. A genetic algorithm (GA) based feature selection technique was used to select the best feature subset from the multi-dimensional feature spaces. The GA-based method was compared to the commonly used feature selection method based on the stepwise linear discriminant analysis (LDA) procedure. Linear discriminant classifiers using the selected features as input predictor variables were formulated for the classification task. The discriminant scores output from the classifiers were analyzed by receiver operating characteristic (ROC) methodology and the classification accuracy was quantified by the area, Az, under the ROC curve. We analyzed a data set of 145 mammographic microcalcification clusters in this study. It was found that the feature subsets selected by the GA-based method are comparable to or slightly better than those selected by the stepwise LDA method. The texture features (Az = 0.84) were more effective than morphological features (Az = 0.79) in distinguishing malignant and benign microcalcifications. The highest classification accuracy (Az = 0.89) was obtained in the combined texture and morphological feature space. The improvement was statistically significant in comparison to classification in either the morphological (p = 0.002) or the texture (p = 0.04) feature space alone. The classifier using the best feature subset from the combined feature space and an appropriate decision threshold could correctly identify 35% of the benign clusters without missing a malignant cluster. When the average discriminant score from all views of the same cluster was used for classification, the Az value increased to 0.93 and the classifier could identify 50% of the benign clusters at 100% sensitivity for malignancy. Alternatively, if the minimum discriminant score from all views of the same cluster was used, the Az value would be 0.90 and a specificity of 32% would be obtained at 100% sensitivity. The results of this study indicate the potential of using combined morphological and texture features for computer-aided classification of microcalcifications.

Algorithms↗
PubMed1998

A room-based diagnostic imaging system for measurement of patient setup.

A room-based diagnostic x-ray imaging system for routine measurement of radiotherapy patient orientation has been developed. The system consists of a pair of room-mounted x-ray tubes and a portable imager consisting of an orthogonal pair of phosphor screens, a mirror/lens system, a CCD camera, and computer software for comparing images of the patient to reference images. Orthogonal pairs of images can be acquired quickly and with relatively little exposure, allowing correction of patient setup on a daily basis. This could limit patient setup error to the uncertainty in the measurement and repositioning processes, a potentially significant improvement over the present standard.

Humans↗
PubMed1997

Computerized classification of malignant and benign microcalcifications on mammograms: texture analysis using an artificial neural network.

We investigated the feasibility of using texture features extracted from mammograms to predict whether the presence of microcalcifications is associated with malignant or benign pathology. Eighty-six mammograms from 54 cases (26 benign and 28 malignant) were used as case samples. All lesions had been recommended for surgical biopsy by specialists in breast imaging. A region of interest (ROI) containing the microcalcifications was first corrected for the low-frequency background density variation. Spatial grey level dependence (SGLD) matrices at ten different pixel distances in both the axial and diagonal directions were constructed from the background-corrected ROI. Thirteen texture measures were extracted from each SGLD matrix. Using a stepwise feature selection technique, which maximized the separation of the two class distributions, subsets of texture features were selected from the multi-dimensional feature space. A backpropagation artificial neural network (ANN) classifier was trained and tested with a leave-one-case-out method to recognize the malignant or benign microcalcification clusters. The performance of the ANN was analysed with receiver operating characteristic (ROC) methodology. It was found that a subset of six texture features provided the highest classification accuracy among the feature sets studied. The ANN classifier achieved an area under the ROC curve of 0.88. By setting an appropriate decision threshold, 11 of the 28 benign cases were correctly identified (39% specificity) without missing any malignant cases (100% sensitivity) for patients who had undergone biopsy. This preliminary result indicates that computerized texture analysis can extract mammographic information that is not apparent by visual inspection. The computer-extracted texture information may be used to assist in mammographic interpretation, with the potential to reduce biopsies of benign cases and improve the positive predictive value of mammography.

Breast Diseases↗
PubMed1996

Uncertainties in CT-based radiation therapy treatment planning associated with patient breathing.

PURPOSE: To evaluate uncertainties associated with treatment-planning computed tomography (CT) data obtained with the patient breathing freely. METHODS AND MATERIALS: Patients with thoracic or abdominal tumors underwent a standard treatment-planning CT study while breathing quietly and freely, followed by CT scans while holding their breath at normal inhalation and normal exhalation. Identical treatment plans on all three CT data sets for each patient pointed out differences in: (a) radiation path lengths; (b) positions of the organs; (c) physical volumes of the lung, liver, and kidneys; (d) the interpretation of plan evaluation tools such as dose-volume histograms and normal tissue complication probability (NTCP) models; and (e) how well the planning CT data set represented the average of the inhalation and exhalation studies. RESULTS: Inhalation and exhalation data differ in terms of radiation path length (nearly one quarter of the cases had path-length differences > 1 cm), although the free breathing and average path lengths do not exhibit large differences (0-9 mm). Liver and kidney movements averaged 2 cm, whereas differences between the free breathing and average positions averaged 0.6 cm. The physical volume of the liver between the free breathing and static studies varied by as much as 12%. The NTCP calculations on exhale and inhale studies varied from 3 to 43% for doses that resulted in a 15% NTCP on the free-breathing studies. CONCLUSION: Free-breathing CT studies may improperly estimate the position and volume of critical structures, and thus may mislead evaluation of plans based on such volume dependent criteria such as dose-volume histograms and NTCP calculations.

Abdominal Neoplasms↗
PubMed1996

Measurement of patient setup errors using port films and a computer-aided graphical alignment tool.

Patient orientations were measured for 49 patients treated in the abdomen, chest, and pelvic regions over the course of 20 months. Setup errors were determined using a curve-matching graphical interface to compare digitized port films to digitized simulation films. Data representing both "initial patient setup" and "patient setup at treatment" are presented and compared. Data were sorted by anatomic area and analyzed both at the population level and on a patient-by-patient basis. For each population, setup errors were observed to be primarily random, with population standard deviations of 5-6 mm for each of three translations and 2-3 degrees for each of two rotations. Rotations about the patients' inferior-superior axes were not measured. For each site, correlations between translations and/or rotations were small. The results are consistent with those from previous studies. The data set is among the largest collected to date.

Abdominal Neoplasms↗
PubMed1996

In phantom determination of collimator scatter factor.

The collimator scatter factor Sc has generally been measured in air using an ionization chamber inside a buildup cap or mini-phantom. Here, Sc was measured in phantom at 10 cm depth for 6 and 15 MV photons with square collimator settings of 2.5-40.0 cm. The results were consistent with in air measurements with a mini-phantom to within 0.4%. In the measurements, a series of Cerrobend field shaping blocks were used to define the field size in the phantom while the collimator settings were varied from the field size in the phantom to twice that value. Corrections of up to 2% for scattered radiation from the added Cerrobend field shaping blocks were necessary. Since a buildup cap or mini-phantom is not used, the smallest field size that can be measured is limited only by the size of the detector and the measurement is performed with full scatter resembling the treatment condition of a patient.

Biometry↗
PubMed1996

Flattening-filter-based empirical methods to parametrize the head scatter factor.

Parametrizing the collimator scatter factor, Sc (or head scatter factor), of a linear accelerator by the side of the equivalent square of the collimator setting at the isocenter does not accurately predict the change in Sc when the width and length of a rectangular field are exchanged. We have studied two methods based on measurements of square fields to predict Sc's of rectangular fields more accurately. The first method parametrizes Sc by the side of the equivalent square of the flattening filter region visible from the point of calculation. The Sc's of rectangular fields were predicted to an accuracy of 1% from measurements with square fields. The second method computes Sc of rectangular configurations by integrating radiation that can reach the point of calculation from a point source at the target and a second extended source at the flattering filter. The radial distribution of the extended source at the level of the flattering filter is computed from Sc of square fields measured at the isocenter. Effects of extended distance are modeled by separately performing inverse square law corrections for the two sources. This method also predicted the measured values to within 1% accuracy.

Biometry↗
PubMed1996

Image compression in digital mammography: effects on computerized detection of subtle microcalcifications.

Our previous receiver operating characteristic (ROC) study indicated that the detection accuracy of microcalcifications by radiologists is significantly reduced if mammograms are digitized at 0.1 mm x 0.1 mm. Our recent study also showed that detection accuracy by computer decreases as the pixel size increases from 0.035 mm x 0.035 mm. It is evident that very large matrix sizes have to be used for digitizing mammograms in order to preserve the information in the image. Efficient compression techniques will be needed to facilitate communication and archiving of digital mammograms. In this study, we evaluated two compression techniques: full frame discrete cosine transform (DCT) with entropy coding and Laplacian pyramid hierarchical coding (LPHC). The dependence of their efficiency on the compression parameters was investigated. The techniques were compared in terms of the trade-off between the bit rate and the detection accuracy of subtle microcalcifications by an automated detection algorithm. The mean-square errors in the reconstructed images were determined and the visual quality of the error images was examined. It was found that with the LPHC method, the highest compression ratio achieved without a significant degradation in the detectability was 3.6:1. The full frame DCT method with entropy coding provided a higher compression efficiency of 9.6:1 at comparable detection accuracy. The mean-square errors did not correlate with the detection accuracy of the microcalcifications. This study demonstrated the importance of determining the quality of the decompressed images by the specific requirements of the task for which the decompressed images are to be used. Further investigation is needed for selection of optimal compression technique for digital mammograms.

Breast Diseases↗