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Biomedical subjects

W A Kalender

Publications and source records attributed to W A Kalender.

At least 55 records · Page 3Linked to original sources

New low-contrast resolution phantoms for computed tomography.

Computed tomography (CT) has been established as a major imaging modality in diagnostic radiology. Accordingly, acceptance testing and quality control of CT scanners is of great importance. While most procedures and phantoms for testing are widely accepted, there is still discussion and uncertainty about low-contrast (LC) sensitivity. In our opinion this unsatisfactory situation is caused at least in part by the lack of suitable phantoms for LC resolution measurements. We investigated the commonly used phantoms for LC detectability, the Catphan, and for LC resolution, the ATS phantom. While the Catphan showed stable object contrasts, the ATS phantom's measured contrast exhibited a strong dependence on temperature and x-ray quality. Based on newly developed polyurethane resin materials, we designed and tested a LC resolution phantom with several different contrast steps. The object contrasts showed no dependence on temperature and beam quality. The new LC resolution phantom proved to be very suitable for measuring a scanner's low-contrast sensitivity in the image plane, one of the most important image quality parameters. To assess LC resolution in three dimensions we designed an additional phantom with rows of spherical objects. A first prototype was evaluated in a multicenter study. The setup proved to be very helpful to quantify the in-plane and axial LC sensitivity of spiral CT scan modes.

Image Enhancement↗

Dose reduction in CT by anatomically adapted tube current modulation. II. Phantom measurements.

Theoretical considerations and simulation studies have led to the expectation that patient dose in CT (computed tomography) can be reduced significantly without a concomitant loss in image quality if tube current is modulated according to rotation angle-dependent x-ray attenuation. In this study, the simulation results presented in Part I were validated with phantoms. We used one cylindrical, two oval, and one elliptical phantom, available both as mathematical descriptions and in physical form, to mimic different parts of the human anatomy. Prototype hardware was available to control tube current on a commercial clinical CT scanner. The potential for dose reduction was evaluated for sinusoidal and attenuation-based current modulation for variable modulation amplitudes. Agreement between simulations and measured results was better than within 10%. Dose reduction values of 8%-56% were found depending on the phantom geometry and tube current modulation function. Attenuation-based tube current modulation consistently yielded higher reduction than fixed-shape sinusoidal modulation functions. For the shoulder phantom and 70% modulation amplitude, 44.6% dose reduction was measured as compared to 34.1% for sinusoidal modulation. A maximum of 56% was measured for the shoulder phantom including inserts. Specifying mAs reduction as an estimate for dose reduction proved to be a valid and conservative estimate; measured dose is reduced more strongly than the total mAs product both centrally and on average. First patient studies confirm the results of simulation and phantom studies. We conclude that attenuation-based online tube current control has great potential for reducing patient dose in CT and that it should be made generally available for clinical use.

Air Pollutants, Radioactive↗

Dose reduction in CT by anatomically adapted tube current modulation. I. Simulation studies.

Tube current modulation governed by x-ray attenuation during CT (computed tomography) acquisition can lead to noise reduction which in turn can be used to achieve patient dose reduction without loss in image quality. The potential of this technique was investigated in simulation studies calculating both noise amplitude levels and noise distribution in CT images. The dependence of noise on the inodulation function, amplitude of modulation, shape and size of the object, and possible phase shift between attenuation and modulation function were examined. Both sinusoidal and attenuation-based control functions were used to modulate tube current. Noise reduction was calculated for both ideal systems and for real systems with limited modulation amplitude. Dose reductions up to 50% can be achieved depending on the phantom geometry and tube current modulation function. Attenuation-based tube current modulation yields substantially higher reduction than fixed-shape modulation functions. Optimal results are obtained when the current is modulated as a function of the square root of attenuation. A modulation amplitude of at least 90% should be available to exploit the potential of these techniques.

Air Pollutants, Radioactive↗

Functional MR imaging of the motor cortex in healthy volunteers and patients with brain tumours: qualitative and quantitative results.

The purpose of this study was to compare functional magnetic resonance (MR) imaging of the motor cortex in healthy volunteers and patients with brain tumours. Functional MR imaging was performed in 14 healthy volunteers and 14 patients with tumours in or near the primary motor cortex with groups being matched for age, sex, and handedness. Functional images were acquired during motion of the right and left hand. Time courses of signal intensity within the contralateral, ipsilateral, and supplementary motor cortex as well as z-maps were calculated, their quality being assessed visually. Mean signal increase between activation and rest were evaluated within the contralateral, ipsilateral, and supplementary motor cortex, the activated area in those regions of interest was measured using z-maps. The quality of functional MR experiments was generally lower in patients than in volunteers. The quantitative results showed a trend towards increased ipsilateral activation in volunteers during left hand compared to right hand motion and in patients during motion of the affected compared to the non-affected hand. Considering quantitative and qualitative results, significantly increased ipsilateral activation was found in patients compared to healthy volunteers. In conclusion, functional MR imaging quality was significantly reduced in patient studies compared to healthy volunteers, even if influences of age, sex, and handedness were excluded. Increased ipsilateral activation was found in patients with brain tumours which can be interpreted by an improved connectivity between both hemispheres.

Adult↗

Virtual cisternoscopy of intracranial vessels: a novel visualization technique using virtual reality.

This paper introduces a different visualization method which we call "virtual cisternoscopy" using 3D MRA data sets. Virtual cisternoscopy uses well known tools, such as perspective volume rendering (pVR), fly-through techniques, and interactive visualization and combines them to a new approach featuring motion to resolve spatial relationships of intracranial vessels and vascular malformations. With a dedicated flight protocol extraluminal topography of intracranial arteries was analyzed using pVR. For evaluation of difficult vascular malformations extraluminal views are necessary. Therefore, movies of pVR views were produced simulating virtual tracks of neurosurgical flexible endoscopes, by flying around the intracranial vessels and vascular malformations within the cisterns. Endoluminal views were acquired additionally for precise evaluation of cases with complex vessel topography. Two healthy volunteers and three patients were examined. Comparing MIP and pVR images relevant advantages of pVR were found, such as depth information, perspective, lighting, and color. In contrast to MIP and source images of the MRA data set, virtual cisternoscopy of an aneurysm of the left middle cerebral artery demonstrated clearly an early origin of an artery in the region of the aneurysm neck/sac. In this case only virtual cisternoscopy led to the correct therapeutical decision. In a newborn, the type of a vein of Galen aneurysmal malformation could only be evaluated reliably by means of virtual cisternoscopy. The third case of a patient with a clipped aneurysm was evaluated more easily with virtual cisternoscopy than with DSA. In conclusion, virtual cisternoscopy may improve the pretherapeutic visualization of intracranial vascular malformations.

Adult↗

Electrocardiogram-correlated image reconstruction from subsecond spiral computed tomography scans of the heart.

Subsecond computed tomography (CT) scanning offers potential for improved heart imaging. We therefore developed and validated dedicated reconstruction algorithms for imaging the heart with subsecond spiral CT utilizing electrocardiogram (ECG) information. We modified spiral CT z-interpolation algorithms on a subsecond spiral CT scanner. Two new classes of algorithms were investigated: (a) 180 degrees CI (cardio interpolation), a piecewise linear interpolation between adjacent spiral data segments belonging to the same heart phase where segments are selected by correlation with the simultaneously recorded ECG signal and (b) 180 degrees CD (cardio delta), a partial scan reconstruction of 180 degrees + delta with delta < fan angle, resulting in reduced effective scan times of less than 0.5 s. Computer simulations as well as processing of clinical data collected with 0.75 s scan time were carried out to evaluate these new approaches. Both 180 degrees CI and 180 degrees CD provided significant improvements in image quality. Motion artifacts in the reconstructed images were largely reduced as compared to standard spiral reconstructions; in particular, coronary calcifications were delineated more sharply and multiplanar reformations showed improved contiguity. However, new artifacts in the image plane are introduced, mostly due to the combination of different data segments. ECG-oriented image reconstructions improve the quality of heart imaging with spiral CT significantly. Image quality and the display of coronary calcification appear adequate to assess coronary calcium measurements with conventional subsecond spiral CT.

Algorithms↗

Unwrapping Cochlear implants by spiral CT.

Multielectrode, intracochlear implants were designed for individuals with profound sensorineural hearing loss who derive little or no benefit form acoustic hearing aids. Determination of each electrode's position in a patient's inner ear may improve speech processor programming to maximize speech recognition. In this paper, an approach is described to use as input a volumetric spiral computed tomography (CT) image of the Nucleus electrode array (Cochlear Pty. Ltd, Lane Cove, NSW, Australia) to unwrap it, and to measure its implanted length given starting and end points. Representative curvilinear structures were digitally synthesized in image volumes of isotropic 0.1-mm voxels. The electrode array was spirally CT-scanned in vitro and in vivo, and reconstructed on an isotropic grid in 0.1-mm steps. Two algorithms were constructed to track and measure these curvilinear structures. The first algorithm is Karhunen-Loeve (K-L)-transform based, in which the K-L transform is locally applied at a current main axis position to determine the eigenvectors of the main axis voxels, the next main axis position is estimated from the current position along the principal eigendirection, adjusted to the mass center of the orthogonal cross section passing through the estimated position, and then scaled to have a prespecified step. The second algorithm is similar to the first one but avoids use of the K-L transform. In the second algorithm, the next position is directly estimated along the local direction and then processed with the same correction and scaling operations. With user-specified starting and end points as well as a local direction at the starting point, a curvilinear structure can be automatically tracked using either of the algorithms. The first algorithm is more robust, while the second one is more efficient. In the numerical and in vitro studies, the lengths of the curvilinear structures were accurately measured. Given local directions determined in the tracking process, an electrode array image can be unwrapped into a linear array with the central electrode axis as the abscissa. The unwrapping approach allows longitudinally and cross-sectionally accurate measurement and better visualization of cochlear implant images. With preimplantation knowledge of length, width, and center electrode distance, the position of individual electrodes can be estimated after unwrapping.

Algorithms↗

The European Spine Phantom--a tool for standardization and quality control in spinal bone mineral measurements by DXA and QCT.

The lack of standardization in bone mineral measurements of the lumbar spine and other skeletal sites is generally recognized as an important and unresolved issue. We report and discuss efforts at standardization and cross-calibration of DXA and QCT equipment. We have designed and tested a geometrically defined, semi-anthropomorphic phantom, the European Spine Phantom (ESP). It contains a spine insert consisting of three vertebrae of increasing bone mineral densities and thicknesses of cortical structures; the respective parameters are given in tabular form for the final phantom design. Results for cross-calibration with the ESP compare well with patient results. Measurements on the first 30 phantoms confirmed that the ESP can be manufactured with a variation of about 1%. We conclude that the ESP is suitable for daily quality assurance, cross-calibration of instruments and universal standardization. The ESP was used to establish standardized BMD (sBMD) units for DXA equipment going into effect in late 1995. Its acceptance by manufacturers as a calibration standard for DXA and QCT measurements appears imminent.

Absorptiometry, Photon↗

Technical foundations of spiral CT.

In spiral CT, complete anatomical volumes are scanned in continuous fashion in typically 20 to 60 seconds, with the inherent possibility to reconstruct images in arbitrarily fine increments from the volume data set. In this paper, we will illustrate the basic principles of scanning and image reconstruction in spiral CT. We will explain the technical prerequisites and limitations. Particular attention is given to considerations on image quality and patient dose.

Angiography↗

Principles and applications of spiral CT.

Spiral CT is a new volume acquisition mode in x-ray computed tomography (CT) which was introduced in 1989. Anatomical ranges are scanned in continuous fashion in typically 20-60s, images can be reconstructed in arbitrarily fine increments at any desired position within the scanned volume. We will illustrate the basic principles of scanning and image reconstruction in spiral CT and explain special features regarding image quality and patient dose. Particular attention is given to improved and new clinical applications, like lesion detection, 3D imaging and CT angiography. Spiral CT has already replaced conventional slice-by-slice CT scanning in many applications and will be the standard scan mode in future CT systems.

Humans↗

Technical foundations of spiral CT.

In spiral CT, complete anatomical volumes are scanned in continuous fashion typically in 20 to 60 seconds, with the inherent possibility to reconstruct images in arbitrarily fine increments from the volume data set. In this article, we illustrate the basic principles of scanning and image reconstruction in spiral CT and explain the technical prerequisites and limitations. Particular attention is given to considerations of image quality and patient dose.

Algorithms↗

Measurement of slice sensitivity profiles in spiral CT.

In conventional computed tomography (CT), ramps, typically thin sheets of aluminum inclined at 45 degrees, are established tools for measurements of slice sensitivity profiles (SSP). In spiral CT, however, they yield inconsistent results for different positions along the longitudinal axis. It is explained herein how ramp profiles result as a superposition of true SSPs and artifacts, the artifacts being caused by the slice interpolation process due to the difficult interpolation condition in this particular geometry. In direct consequence, ramp tests yield spatially variant results. As an alternative tool for measuring the slice sensitivity profile, the use of a thin high-contrast sheet held between two disks which approximate the ideal test of a delta impulse in the longitudinal direction is suggested. Resulting SSPs are shown for both methods; the delta method, in agreement with theoretical predictions, provided smooth symmetrical SSPs independent of table position in agreement with theoretical predictions. It is concluded that ramps are inadequate test objects to determine SSPs in spiral CT.

Biophysical Phenomena↗

[Basic principles of vascular imaging with spiral CT].

Vascular investigations by CT have experienced a decisive advance and found a high acceptance since the introduction of fast volume scanning (spiral CT). We have investigated the underlying physical foundations and optimized the operational aspects of the method now introduced as CT angiography (CTA). Investigations are carried out with a table feed of 1-10 mm/s. Images are reconstructed at 1-2 mm separations by use of algorithms which optimize the layer profile. The parameters must be adapted to the region being investigated. The diagnosis is generally made with interactive cine runs; for this the original images, multiplanar reformations, 3D surface shaded displays (SSD), and maximum intensity projection (MIP) images are used. The 3D representations are discussed in the context of the principle and illustrative examples. Important applications for CTA are the evaluation of aortic aneurysms and dissections, pulmonary vessels, renal arteries, and vessel stents. CTA is characterized by short examination times, low invasiveness, and relatively low cost; in typical cases it is associated with an effective dose of 2-10 mSv. The advantages and disadvantages of the new method are discussed in terms of diagnostic value, image quality, patient dose, contrast medium techniques, and practical aspects in comparison to other angiographic methods.

Algorithms↗

Determination of the position of nucleus cochlear implant electrodes in the inner ear.

Accurate determination of intracochlear electrode position in patients with cochlear implants could provide a basis for detecting migration of the implant and could aid in the selection of stimulation parameters for sound processor programming. New computer algorithms for submillimeter resolution and 3-D reconstruction from spiral computed tomographic (CT) scans now make it possible to accurately determine the position of implanted electrodes within the cochlear canal. The accuracy of these algorithms was tested using an electrode array placed in a phantom model. Measurements of electrode length and interelectrode distance from spiral CT scan reconstructions were in close agreement with those from stereo microscopy. Although apparent electrode width was increased on CT scans due to partial volume averaging, a correction factor was developed for measurements from conventional radiographs and an expanded CT absorption value scale added to detect the presence of platinum electrodes and wires. The length of the cochlear canal was calculated from preoperative spiral CT scans for one patient, and the length of insertion of the electrode array was calculated from her postoperative spiral CT scans. The cross-sectional position of electrodes in relation to the outer bony wall and modiolus was measured and plotted as a function of distance with the electrode width correction applied.

Adult↗

[Vascular imaging with spiral-CT. The path to CT-angiography].

Spiral CT is a technique that allows for high-quality two-dimensional angiographic projections and 3D imaging of vascular structures. The authors present the technical and methodological principles of the technique, including scan parameters and parameters of contrast application for various clinical imaging tasks. They present their experience with over 150 clinical cases using spiral CT angiography. Suitable applications of this technique include congenital anomalies, aneurysms, dissections, stenoses, thrombi and vascular tumor involvement. Given a problem-adapted examination technique, pathologic changes in vessels of as little as 2 mm can be visualized. In some cases with complex vascular anatomy, spiral CT angiography can be superior to arterial angiography.

Forecasting↗

Compact and trabecular components of the spine using quantitative computed tomography.

A computer algorithm was employed to quantify separately cortical and trabecular bone mineral density (BMD) from single energy computed tomography (CT) scans of 139 vertebrae (L1-L3) of 50 normal female subjects. In addition, the trabecular-to-integral and cortical-to-integral mass ratios were determined using digital image segmentation techniques. They showed that for the central 8-mm vertebral slice, the mass of integral bone consists of about one-fifth trabecular and four-fifth cortical bone. The trabecular-to-integral volume ratios were 0.37 +/- 0.08 and 0.63 +/- 0.08, respectively. Based on cross-sectional data from this subject group, the average annual loss was -2.21 +/- 0.15 mg/cm3 or -1.84 +/- 0.12% for trabecular bone, -3.15 +/- 0.25 mg/cm3 or -1.01 +/- 0.08% for cortical bone, and -2.60 +/- 0.20 mg/cm3 or -1.09 +/- 0.09% for the integral bone. The proportions of the age-related loss of BMD from the integral bone which originated from trabecular and cortical bone were 29.5 and 70.5%, respectively.

Adult↗