[New developments in computer tomography: EKG-correlated subsecond multi-slice spiral CT].
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Anatomy, Cross-Sectional↗
Biomedical subjects
W A Kalender
Publications and source records attributed to W A Kalender.
Noninvasive coronary angiography by retrospectively ECG-gated multislice spiral CT.
BACKGROUND: We investigated the applicability and image quality of contrast-enhanced coronary artery visualization by multislice spiral CT using retrospective ECG gating. METHODS AND RESULTS: Twenty-five patients in sinus rhythm (significant coronary artery stenoses ruled out by invasive angiography) were studied with a multislice spiral CT (Siemens SOMATOM Volume Zoom). In inspiration (mean breath-hold, 37 seconds), a volume data set of the heart was acquired (intravenous contrast agent; 4 x 1-mm slice thickness; 500-ms rotation; table feed, 1.5 mm/360 degrees ). Simultaneous recording of the ECG permitted retrospective reconstruction of contiguous cross sections in intervals of 1 mm at any desired interval of the cardiac cycle. The mean duration of the image reconstruction window was 185 ms. Next to 3-dimensional reconstructions of the heart and coronary arteries, multiplanar reconstructions were rendered to determine the visualized length of the coronary arteries, the contrast-to-noise ratio, and the correlation of coronary artery diameters to quantitative coronary angiography. CONCLUSIONS: The coronary arteries could be visualized over long segments (left main, 9+/-4 mm; left anterior descending, 112+/-34 mm; left circumflex, 80+/-29 mm; right coronary artery, 116+/-33 mm). On average, 78+/-16% of these distances were visualized free of motion artifacts. The mean contrast-to-noise ratio was 9.3+/-3.3. Coronary artery diameters in multislice spiral CT showed close correlation to quantitative coronary angiography (CT, 3.3+/-1.0 mm; angiography, 3. 2+/-0.9 mm; mean difference, 0.38 mm; r=0.86). Contrast-enhanced multislice spiral CT permits visualization of the coronary artery lumen. Further studies are necessary to determine whether image quality is sufficient to reliably detect coronary artery stenoses.
Adult↗
[Construction and use of a virtual anthropomorphic phantom of the bronchial tree].
MOTIVATION: Usually, phantoms are used to quantify properties of computer algorithms working on spiral CT data. The high complexity of the human bronchial tree, however, complicates the construction of a physical phantom enormously; hence, a virtual phantom must be employed. METHODS: Because the human bronchial tree is fractal, Lindenmayer systems were utilized to generate its structure. Applying the correct diameter and length ratios and branching angles, a virtual anthropomorphic phantom could be generated by a three-dimensional turtle graphic. The simulation of a spiral CT measurement on the virtual phantom delivered synthetic spiral CT data. RESULTS: The computer-controlled growing process supplies exact morphologic and morphometric data. The spiral CT simulation saves the time-consuming and complicated generation of a physical phantom. PERSPECTIVE: The virtual phantom can be completed by the introduction of blood vessels and lung parenchyma partitioned into lobes and segments. The field of application can thus be extended.
Anthropometry↗
[Subsecond multislice spiral CT as an alternative to electron beam computerized tomography].
X-ray computed tomography (CT) has exhibited rapid technological advances in recent years which has made it a potential alternative to electron beam computed tomography (EBCT). In addition to the development of spiral CT, rotation times in the subsecond range and the development of multislice detectors were decisive steps. These technical developments will be sketched briefly; the necessary adaptation of image reconstruction and evaluation will be explained. Particular emphasis will be placed on the necessary steps of quality assurance and calibration in quantitative procedures, as for example coronary calcium measurements. The exposure for typical CT examinations of the heart are in the order of half to five times the natural exposure per year. With synchronous recording of the ECG, the complete heart can be imaged continuously with thin slices and high spatial resolution in less than 30 s. In spite of the very short validation phase up to now, we consider multislice spiral CT an alternative to EBCT.
Calibration↗
Technical advances in multi-slice spiral CT.
X-ray computerised tomography (CT) scanning with continuous patient transport has been established under the name Spiral CT since several years as the standard clinical examination procedure. This technique has been improved continuously with respect to scan speed, temporal response and z-axis resolution by the use of latest technical developments: Rotation times up to 0.5 s and multi-row detector array systems. Today detector systems with M + 4 simultaneously measured slices are available. We report about recent progress of spiral CT reconstruction algorithms that are based on multi-slice data. It is demonstrated that the new technology not only provides significant reduction in overall scan times and thereby of the CT scanner?s X-ray tube load; beyond that, the new technology allows CT imaging of the beating heart with high level image quality in standard clinical routine.
Algorithms↗
Medical volume exploration: gaining insights virtually.
Since modern imaging modalities deliver huge amounts of data, which cannot be assessed easily, the visualization techniques are utilized to emphasize the structures of interest. To compare them, the different visualization techniques (maximum intensity projection, multiplanar reformations, shaded surface display and volume rendering) are regressed to a common ground whereby their strengths and weaknesses can be revealed. Additionally, medical image analysis can detect anatomical objects in volumetric data sets and provides their descriptions for further use. Usually, segmentation plays a crucial roll in that process. There are many segmentation methods which can be categorized in boundary-based and content-based ones. The extraction of anatomical objects also allows their quantification. Image analysis and visualization do not squeeze more information out of a data volume, but they provide different ways to look at it. As in real life, this alone may enlarge the insight.
Algorithms↗
Spiral interpolation algorithm for multislice spiral CT--part I: theory.
This paper presents the adaptive axial interpolator (AAI), a novel spiral interpolation approach for multislice spiral computed tomography (CT) implemented in a clinical multislice CT scanner, the SOMATOM Volume Zoom (Siemens Medical Systems, Forchheim, Germany). The method works on parallel-beam data generated from the acquired fan-beam data by azimuthal rebinning. Spiral interpolation is performed by distance-dependent weighting; i.e., for each ray, its distance to the image plane is evaluated and serves as an argument to a freely selectable weighting function, resulting in a weight factor. A normalization step is applied to the weight factors to ensure that the sum of all corresponding weights (i.e., the weights applied to rays that contribute to the same ray in the interpolated sinogram) is 1. By selection of appropriate weighting functions and suitable adjustment of the tube current, it is possible to keep the slice sensitivity profiles (SSP) as well as the pixel noise constant for all pitch values in the relevant range. Also, a large range of slice-thickness can be reconstructed from a given collimation. The method is, thus, very versatile. Further advantages are that it uses the entire applied dose for imaging and allows for efficient implementation using a table lookup approach.
Algorithms↗
Spiral interpolation algorithms for multislice spiral CT--part II: measurement and evaluation of slice sensitivity profiles and noise at a clinical multislice system.
The recently introduced multislice data acquisition for computed tomography (CT) is based on multirow detector design, increased rotation speed, and advanced z-interpolation and z-filtering algorithms. We evaluated slice sensitivity profiles (SSPs) and noise of a clinical multislice spiral CT (MSCT) scanner with M = 4 simultaneously acquired slices and adaptive axial interpolator (AAI) reconstruction software. SSPs were measured with a small gold disk of 50 microm thickness and 2-mm diameter located at the center of rotation (COR) and 100 mm off center. The standard deviation of CT values within a 20-cm water phantom was used as a measure of image noise. With a detector slice collimation of S = 1.0 mm, we varied spiral pitch p from 0.25 to 2.0 in steps of 0.025. Nominal reconstructed slice thicknesses were 1.25, 1.5, and 2.0 mm. For all possible pitch values, we found the full-width at half maximum (FWHM) of the respective sensitivity profile at the COR equivalent to the selected nominal slice thickness. The profiles at 100 mm off center are broadened less than 7 % on the average compared with the FWHM at the COR. In addition, variation of the full-width at tenth maximum (FWTM) at the COR was below 10% for p < or = 1.75. Within this range, image noise varied less than 10% with respect to the mean noise level. The slight increase in measured slice-width above p = 1.75 for nominal slice-widths of 1.25 and 1.50 mm is accompanied by a decrease of noise according to the inverse square root relationship. The MSCT system that we scrutinized provides reconstructed slice-widths and image noise, which can be regarded as constant within a wide range of table speeds. With respect to this, MSCT is superior to single-slice spiral CT. These facts can be made use of when defining and optimizing clinical protocols: the spiral pitch can be selected almost freely, and scan protocols can follow the diagnostic requirements without technical restrictions. In summary, MSCT offers constant image quality while scan times are reduced drastically. Volume scans with three-dimensional (3-D) isotropic resolution are routinely feasible for complete anatomical regions.
Algorithms↗
ECG-correlated imaging of the heart with subsecond multislice spiral CT.
The new spiral multislice computed tomography (CT) scanners and the significant increase in rotation speed offer great potential for cardiac imaging with X-ray CT. We have therefore developed the dedicated cardiac reconstruction algorithms 180 degrees multislice cardio interpolation (MCI) and 180 degrees multislice cardio delta (MCD) and here offer further details and validation. The algorithm 180 degreesMCI is an electrocardiogram (ECG)-correlated filtering (or weighting) algorithm in both the cardiac phase and in the z-position. Effective scan times (absolute temporal resolution) of as low as t(eff) = 56 ms are possible, assuming M 4 simultaneously measured slices at a rotation time of t(rot) = 0.5 s and S < or = d < or = 3S for the table feed d per rotation, where S denotes the collimated slice thickness. The relative temporal resolution w (fraction of the heart cycle depicted in the image), which is the more important parameter in cardiac imaging, will then be as low as w = 12.5% of the heart cycle. The second approach, 180 degreesMCD, is an ECG-correlated partial scan reconstruction of 180 degrees + delta data with delta << phi (fan-angle). Its absolute temporal resolution lies in the order of 250 ms (for the central ray, i.e., for the center of rotation), and the relative temporal resolution w increases with increasing heart rate, e.g., from typically w = 25% at fH = 60 min(-1) to w = 50% at fH = 120 min(-1), assuming again t(rot) = 0.5 s. For validation purposes, we have done simulations of a virtual cardiac motion phantom, measurements of a dedicated cardiac calibration and motion phantom, and we have reconstructed patient data with simultaneously acquired ECG. Both algorithms significantly improve the image quality compared with the standard reconstruction algorithms 180 degrees multislice linear interpolation (MLI) and 180 degrees multislice filtered interpolation (MFI). However, 180 degreesMCI is clearly superior to 180 degreesMCD for all heart rates. This is best illustrated by multiplanar reformations (MPR) or other three-dimensional (3-D) displays of the volume. 180 degreesMCI, due to its higher temporal resolution, is best for spatial and temporal four-dimensional (4-D) tracking of the anatomy. A tunable scanner rotation time to avoid resonance behavior of the heart rate and the scanner's rotation and shorter rotation times would be of further benefit.
Algorithms↗
Direct comparison of a xenon and a solid-state CT detector system: measurements under working conditions.
Measurements of various image quality parameters were carried out with two different detector systems in an otherwise unchanged medical computed tomography (CT) scanner. As all other components of the scanner and the image reconstruction system remained identical, we were able to quantify the difference in performance between a Xenon gas ionization detector and a new solid-state scintillation detector in an isolated fashion. We determined noise, spatial resolution, and artifact behavior and assessed the potential for dose reduction. No significant impact of the detector change on absolute CT values of a calibration phantom was observed. Spatial resolution was improved by more than 10% for the solid-state system. As the system's modulation transfer functions were measured with a wire phantom and otherwise unchanged scanner geometry and image reconstruction algorithm, the increase of resolution is explained by the improved temporal response of the solid-state detector. At the same time, noise was reduced by 12% for a 20-cm diameter water phantom. The noise reduction corresponds to a possible reduction of patient dose by 23% for constant image quality, which is in good agreement with our prediction by estimations of both systems total detective quantum efficiency. Also, a significant improvement of scatter rejection was found for the solid-state system.
Ceramics↗
Multirow detector and cone-beam spiral/helical CT.
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Algorithms↗
ECG-correlated image reconstruction from subsecond multi-slice spiral CT scans of the heart.
Subsecond spiral computed tomography (CT) offers great potential for improving heart imaging. The new multi-row detector technology adds significantly to this potential. We therefore developed and validated dedicated cardiac reconstruction algorithms for imaging the heart with subsecond multi-slice spiral CT utilizing electrocardiogram (ECG) information. The single-slice cardiac z-interpolation algorithms 180 degrees CI and 180 degrees CD [Med. Phys. 25, 2417-2431 (1998)] were generalized to allow imaging of the heart for M-slice scanners. Two classes of algorithms were investigated: 180 degrees MCD (multi-slice cardio delta), a partial scan reconstruction of 180 degrees + delta data with a < phi (fan angle) resulting in effective scan times of 250 ms (central ray) when a 0.5 s rotation mode is available, and 180 degrees MCI (multi-slice cardio interpolation), a piecewise weighted interpolation between successive spiral data segments belonging to the same heart phase, potentially providing a relative temporal resolution of 12.5% of the heart cycle when a four-slice scanner is used and the table increment is chosen to be greater than or equal to the collimated slice thickness. Data segments are selected by correlation with the simultaneously recorded ECG signal. Theoretical studies, computer simulations, as well as patient measurements were carried out for a multi-slice scanner providing M = 4 slices to evaluate these new approaches and determine the optimal scan protocol. Both algorithms, 180 degrees MCD and 180 degrees MCI, provide significant improvements in image quality, including extremely arythmic cases. Artifacts in the reconstructed images as well as in 3D displays such as multiplanar reformations were largely reduced as compared to the standard z-interpolation algorithm 180 degrees MLI (multi-slice linear interpolation). Image quality appears adequate for precise calcium scoring and CT angiography of the coronary arteries with conventional subsecond multislice spiral CT. It turned out that for heart rates fH > or = 70 min(-1) the partial scan approach 180 degrees MCD yields unsatisfactory results as compared to 180 degrees MCI. Our theoretical considerations show that a freely selectable scanner rotation time chosen as a function of the patient's heart rate, would further improve the relative temporal resolution and thus further reduce motion artifacts. In our case an additional 0.6 s mode besides the available 0.5 s mode would be very helpful. Moreover, if technically feasible, lower rotation times such as 0.3 s or even less would result in improved image quality. The use of multi-slice techniques for cardiac CT together with the new z-interpolation methods improves the quality of heart imaging significantly. The high temporal resolution of 180 degrees MCI is adequate for spatial and temporal tracking of anatomic structures of the heart (4D reconstruction).
Algorithms↗
Advanced single-slice rebinning in cone-beam spiral CT.
To achieve higher volume coverage at improved z-resolution in computed tomography (CT), systems with a large number of detector rows are demanded. However, handling an increased number of detector rows, as compared to today's four-slice scanners, requires to accounting for the cone geometry of the beams. Many so-called cone-beam reconstruction algorithms have been proposed during the last decade. None met all the requirements of the medical spiral cone-beam CT in regard to the need for high image quality, low patient dose and low reconstruction times. We therefore propose an approximate cone-beam algorithm which uses virtual reconstruction planes tilted to optimally fit 180 degrees spiral segments, i.e., the advanced single-slice rebinning (ASSR) algorithm. Our algorithm is a modification of the single-slice rebinning algorithm proposed by Noo et al. [Phys. Med. Biol. 44, 561-570 (1999)] since we use tilted reconstruction slices instead of transaxial slices to approximate the spiral path. Theoretical considerations as well as the reconstruction of simulated phantom data in comparison to the gold standard 180 degrees LI (single-slice spiral CT) were carried out. Image artifacts, z-resolution as well as noise levels were evaluated for all simulated scanners. Even for a high number of detector rows the artifact level in the reconstructed images remains comparable to that of 180 degrees LI. Multiplanar reformations of the Defrise phantom show none of the typical cone-beam artifacts usually appearing when going to larger cone angles. Image noise as well as the shape of the respective slice sensitivity profiles are equivalent to the single-slice spiral reconstruction, z-resolution is slightly decreased. The ASSR has the potential to become a practical tool for medical spiral cone-beam CT. Its computational complexity lies in the order of standard single-slice CT and it allows to use available 2D backprojection hardware.
Algorithms↗
[Basics and techniques of spiral CT].
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Equipment Design↗
Dose reduction in CT by on-line tube current control: principles and validation on phantoms and cadavers.
We investigated approaches to reducing the dose in CT without impairing image quality. Dose can be reduced for non-circular object cross-sections without a significant increase in noise if X-ray tube current is reduced at angular tube positions where the X-ray attenuation by the patients is small. We investigated different schemes of current modulation during tube rotation by simulation and phantom measurements. Both pre-programmed sinusoidal modulation functions and attenuation-based on-line control of the tube current were evaluated. All relevant scan parameters were varied, including constraints such as the maximum modulation amplitude. A circular, an elliptical and two oval water phantoms were used. Results were validated on six cadavers. Dose reduction of 10-45% was obtained both in simulations and in measurements for the different non-circular phantom geometries and current modulation algorithms without an increase in pixel noise values. On-line attenuation-based control yielded higher reductions than modulation by a sinusoidal curve. The maximal dose reduction predicted any simulations could not be achieved due to limits in the modulation amplitude. In cadaver studies, a reduction of typically 20-40% was achieved for the body and about 10% for the head. Variations of our technique are possible; a slight increase in nominal tube current for high-attenuation projections combined with attenuation-based current modulation still yields significant dose reduction, but also a reduction in the structured noise that may obscure diagnostic details. We conclude that a significant reduction in dose can be achieved by tube current modulation without compromising image quality. Attenuation-based on-line control and a modulation amplitude of at least 90% should be employed.
Cadaver↗
A PC program for estimating organ dose and effective dose values in computed tomography.
Dose values in CT are specified by the manufacturers for all CT systems and operating conditions in phantoms. It is not trivial, however, to derive dose values in patients from this information. Therefore, we have developed a PC-based program which calculates organ dose and effective dose values for arbitrary scan parameters and anatomical ranges. Values for primary radiation are derived from measurements or manufacturer specifications; values for scattered radiation are derived from Monte Carlo calculations tabulated for standard anthropomorphic phantoms. Based on these values, organ doses can be computed by the program for arbitrary scan protocols in conventional and in spiral CT. Effective dose values are also provided, both with ICRP 26 and ICRP 60 tissue-weighting coefficients. Results for several standard CT protocols are presented in tabular form in this paper. In addition, potential for dose reduction is demonstrated, for example, in spiral CT and in quantitative CT. Providing realistic patient dose estimates for arbitrary CT protocols is relevant both for the physician and the patient, and it is particularly useful for educational and training purposes. The program, called WinDose, is now in use at the Erlangen University hospitals (Germany) as an information tool for radiologists and patients. Further extensions are planned.
Dose-Response Relationship, Radiation↗
[Dosage reduction in computed tomography by anatomy-oriented attenuation-based tube-current modulation: the first clinical results].
PURPOSE: To examine the feasibility of reducing exposition in CT examinations by applying a prototype device for tube current modulation with the image quality remaining unchanged. PATIENTS AND METHODS: The prototype device for tube current modulation was integrated into a Somatom Plus 4 CT scanner (Siemens). The method is based on anatomy-oriented modulation of the tube current. The attenuation of the X-ray beam by the patient's body was determined online, the tube current was adapted to changing anatomy after a delay of 180 degrees. In ten patients undergoing radiotherapy, four identical scans of the shoulder region were carried out with and without tube current modulation. For determining dose reduction, mAs product of both scans were compared. The evaluation of noise artifacts, low contrast detectability and overall image quality was performed by four radiologists in a blinded fashion. RESULTS: Patient doses could be reduced by 38% on an average. Scans with tube current modulation were superior to scans without it as to noise (75%), low contrast detectability (51%), artifacts (69%), and overall image quality (71%). CONCLUSIONS: A significant reduction in exposition during CT can be achieved by anatomy-oriented tube current modulation without image degradation.
Artifacts↗
Accuracy limits for the determination of cortical width and density: the influence of object size and CT imaging parameters.
In this study we analysed the accuracy of computed tomography (CT) measurements in assessing cortical bone. We determined the dependency of thickness and density measurements on the true width and density of the cortex and on the spatial resolution in the CT images using two optimized segmentation methods. As a secondary goal, we assessed the ability of CT to reflect small changes in cortical thickness. Two different bone-mimicking phantoms with varying cortical thickness were scanned with single-slice CT on a Somatom Plus 4 scanner. Images were reconstructed with both a standard and a high-resolution convolution kernel. Two special operator-independent segmentation methods were used to automatically detect the edges of the cortical shell. We measured cortical thickness and density and compared the phantom measurements with theoretical computations by simulating a cross-sectional shape of the cortical shell. Based on the simulations, we calculated CT's power to detect small changes in cortical thickness. Simulations and phantom measurements were in very good agreement. Cortical thickness could be measured with an error of less than 10% if the true thickness was larger than 0.9 (0.7) mm for the standard (high-resolution) kernel which is close to the full width at half maximum (FWHM) of the point spread functions for these kernels and our scanner. Density measurements yielded errors of less than 10% for true cortical thickness values above two to three times the FWHM corresponding to 2.5 (2) mm in our case. The simulations showed that a 10% change in cortical width would not be detected with satisfying probability in bones with a cortical shell thinner than 1.2 mm. An accurate determination of the cortical thickness is limited to bones with a thickness higher than the FWHM of the scanner's point spread function. Therefore, the use of a high-resolution reconstruction kernel is crucial. Cortical bone mineral density can only be measured accurately in bones two to three times thicker than this number. In thinner bones, the measured density becomes dependent on the thickness. Changes in cortical thickness can only be assessed if the change is rather large or if the measured bone has sufficient thickness. Therefore, assessing density or thickness of the vertebral shell by CT should be treated with caution.
Bone Density↗