Evaluation of the combined effects of target size, respiratory motion and background activity on 3D and 4D PET/CT images

Gated (4D) PET/CT has the potential to greatly improve the accuracy of radiotherapy at treatment sites where internal organ motion is significant. However, the best methodology for applying 4D-PET/CT to target definition is not currently well established. With the goal of better understanding how to best apply 4D information to radiotherapy, initial studies were performed to investigate the effect of target size, respiratory motion and target-to-background activity concentration ratio (TBR) on 3D (ungated) and 4D PET images. Using a PET/CT scanner with 4D or gating capability, a full 3D-PET scan corrected with a 3D attenuation map from 3D-CT scan and a respiratory gated (4D) PET scan corrected with corresponding attenuation maps from 4D-CT were performed by imaging spherical targets (0.5-26.5 mL) filled with (18)F-FDG in a dynamic thorax phantom and NEMA IEC body phantom at different TBRs (infinite, 8 and 4). To simulate respiratory motion, the phantoms were driven sinusoidally in the superior-inferior direction with amplitudes of 0, 1 and 2 cm and a period of 4.5 s. Recovery coefficients were determined on PET images. In addition, gating methods using different numbers of gating bins (1-20 bins) were evaluated with image noise and temporal resolution. For evaluation, volume recovery coefficient, signal-to-noise ratio and contrast-to-noise ratio were calculated as a function of the number of gating bins. Moreover, the optimum thresholds which give accurate moving target volumes were obtained for 3D and 4D images. The partial volume effect and signal loss in the 3D-PET images due to the limited PET resolution and the respiratory motion, respectively were measured. The results show that signal loss depends on both the amplitude and pattern of respiratory motion. However, the 4D-PET successfully recovers most of the loss induced by the respiratory motion. The 5-bin gating method gives the best temporal resolution with acceptable image noise. The results based on the 4D scan protocols can be used to improve the accuracy of determining the gross tumor volume for tumors in the lung and abdomen.     

Respiratory correlated cone-beam computed tomography on an isocentric C-arm

A methodology for 3D image reconstruction from retrospectively gated cone-beam CT projection data has been developed. A mobile x-ray cone-beam device consisting of an isocentric C-arm equipped with a flat panel detector was used to image a moving phantom. Frames for reconstruction were retrospectively selected from complete datasets based on the known rotation of the C-arm and a signal from a respiratory monitor. Different sizes of gating windows were tested. A numerical criterion for blur on the reconstructed image was suggested. The criterion is based on minimization of an Ising energy function, similar to approaches used in image segmentation or restoration. It is shown that this criterion can be used for the determination of the optimal gating window size. Images reconstructed from the retrospectively gated projection sequences using the optimal gating window data showed a significant improvement compared to images reconstructed from the complete projection datasets.     

Fusion of respiration-correlated PET and CT scans: correlated lung tumour motion in anatomical and functional scans

Lower lobe lung tumours in particular can move up to 2 cm in the cranio-caudal direction during the respiration cycle. This breathing motion causes image artefacts in conventional free-breathing computed tomography (CT) and positron emission tomography (PET) scanning, rendering delineation of structures for radiotherapy inaccurate. The purpose of this study was to develop a method for four-dimensional (4D) respiration-correlated (RC) acquisition of both CT and PET scans and to develop a framework to fuse these modalities. The breathing signal was acquired using a thermometer in the breathing airflow of the patient. Using this breathing signal, the acquired CT and PET data were grouped to the corresponding respiratory phases, thereby obtaining 4D CT and PET scans. Tumour motion curves were assessed in both image modalities. From these tumour motion curves, the deviation with respect to the mean tumour position was calculated for each phase. The absolute position of the centre of the tumour, relative to the bony anatomy, in the RCCT and gated PET scans was determined. This 4D acquisition and 4D fusion methodology was performed for five patients with lower lobe tumours. The peak-to-peak amplitude range in this sample group was 1-2 cm. The 3D tumour motion curve differed less than 1 mm between PET and CT for all phases. The mean difference in amplitude was less than 1 mm. The position of the centre of the tumour (relative to the bony anatomy) in the RCCT and gated PET scan was similar (difference <1 mm) when no atelectasis was present. Based on these results, we conclude that the method described in this study allows for accurate quantification of tumour motion in CT and PET scans and yields accurate respiration-correlated 4D anatomical and functional information on the tumour region.     

A motion-incorporated reconstruction method for gated PET studies

Cardiac and respiratory motion artefacts in PET imaging have been traditionally resolved by acquiring the data in gated mode. However, gated PET images are usually characterized by high noise content due to their low photon statistics. In this paper, we present a novel 4D model for the PET imaging system, which can incorporate motion information to generate a motion-free image with all acquired data. A computer simulation and a phantom study were conducted to test the performance of this approach. The computer simulation was based on a digital phantom that was continuously scaled during data acquisition. The phantom study, on the other hand, used two spheres in a tank of water, all of which were filled with (18)F water. One of the spheres was stationary while the other moved in a sinusoidal fashion to simulate tumour motion in the thorax. Data were acquired using both 4D CT and gated PET. Motion information was derived from the 4D CT images and then used in the 4D PET model. Both studies showed that this 4D PET model had a good motion-compensating capability. In the phantom study, this approach reduced quantification error of the radioactivity concentration by 95% when compared to a corresponding static acquisition, while signal-to-noise ratio was improved by 210% when compared to a corresponding gated image.     

Individualized gating windows based on four-dimensional CT information for respiration-gated radiotherapy

The purpose of this work is to relate the gating window and displacement of a moving tumor target and develop a systematic method to individualize the gating window for respiration-gated radiation therapy (RT). As the relationship between patient anatomy and respiration phase is contained in 4D images, we aim to quantify this information and utilize the data to guide gated treatment planning. After 4D image acquisition, the target and organs at risk were delineated manually on the selected gating phase. The contours were propagated automatically onto every phase-specific image set using a control volume-based contour mapping technique. The mean and maximum distances between the contours in the gating phase and each of other phases were evaluated in three dimensions. The gating window was determined in such a way that the residual movement of the target within the window is smaller or equal to the patient's setup error. The proposed method was applied to plan the gated treatments of 12 lung cancer patients. As a result of this work, a method to calculate patient-specific gating windows has been developed. The general reference drawn from this study is that, with the aide of 4D images and automated 4D contour propagation, it is feasible to individualize the gating widow selection. As compared with the current practice, the proposed technique has a potential to eliminate the guesswork involved in choosing a gating window and avoid dosimetric error in planning gated RT. In conclusion, individualization of gating windows reduces the subjectivity in respiration-gated RT and improves the treatment of moving targets.     

Respiratory gating in positron emission tomography: a quantitative comparison of different gating schemes

Respiratory gating is used for reducing the effects of breathing motion in a wide range of applications from radiotherapy treatment to diagnostical imaging. Different methods are feasible for respiratory gating. In this study seven gating methods were developed and tested on positron emission tomography (PET) listmode data. The results of seven patient studies were compared quantitatively with respect to motion and noise. (1) Equal and (2) variable time-based gating methods use only the time information of the breathing cycle to define respiratory gates. (3) Equal and (4) variable amplitude-based gating approaches utilize the amplitude of the respiratory signal. (5) Cycle-based amplitude gating is a combination of time and amplitude-based techniques. A baseline correction was applied to methods (3) and (4) resulting in two new approaches: Baseline corrected (6) equal and (7) variable amplitude-based gating. Listmode PET data from seven patients were acquired together with a respiratory signal. Images were reconstructed applying the seven gating methods. Two parameters were used to quantify the results: Motion was measured as the displacement of the heart due to respiration and noise was defined as the standard deviation of pixel intensities in a background region. The amplitude-based approaches (3) and (4) were superior to the time-based methods (1) and (2). The improvement in capturing the motion was more than 30% (up to 130%) in all subjects. The variable time (2) and amplitude (4) methods had a more uniform noise distribution among all respiratory gates compared to equal time (1) and amplitude (3) methods. Baseline correction did not improve the results. Out of seven different respiratory gating approaches, the variable amplitude method (4) captures the respiratory motion best while keeping a constant noise level among all respiratory phases.     

Rigid-body transformation of list-mode projection data for respiratory motion correction in cardiac PET

High-resolution cardiac PET imaging with emphasis on quantification would benefit from eliminating the problem of respiratory movement during data acquisition. Respiratory gating on the basis of list-mode data has been employed previously as one approach to reduce motion effects. However, it results in poor count statistics with degradation of image quality. This work reports on the implementation of a technique to correct for respiratory motion in the area of the heart at no extra cost for count statistics and with the potential to maintain ECG gating, based on rigid-body transformations on list-mode data event-by-event. A motion-corrected data set is obtained by assigning, after pre-correction for detector efficiency and photon attenuation, individual lines-of-response to new detector pairs with consideration of respiratory motion. Parameters of respiratory motion are obtained from a series of gated image sets by means of image registration. Respiration is recorded simultaneously with the list-mode data using an inductive respiration monitor with an elasticized belt at chest level. The accuracy of the technique was assessed with point-source data showing a good correlation between measured and true transformations. The technique was applied on phantom data with simulated respiratory motion, showing successful recovery of tracer distribution and contrast on the motion-corrected images, and on patient data with C15O and 18FDG. Quantitative assessment of preliminary C15O patient data showed improvement in the recovery coefficient at the centre of the left ventricle.     

Non-contact respiration monitoring for in-vivo murine micro computed tomography: characterization and imaging applications

A cone beam micro-CT has previously been utilized along with a pressure-tracking respiration sensor to acquire prospectively gated images of both wild-type mice and various adult murine disease models. While the pressure applied to the abdomen of the subject by this sensor is small and is generally without physiological effect, certain disease models of interest, as well as very young animals, are prone to atelectasis with added pressure, or they generate too weak a respiration signal with this method to achieve optimal prospective gating. In this work we present a new fibre-optic displacement sensor which monitors respiratory motion of a subject without requiring physical contact. The sensor outputs an analogue signal which can be used for prospective respiration gating in micro-CT imaging. The device was characterized and compared against a pneumatic air chamber pressure sensor for the imaging of adult wild-type mice. The resulting images were found to be of similar quality with respect to physiological motion blur; the quality of the respiration signal trace obtained using the non-contact sensor was comparable to that of the pressure sensor and was superior for gating purposes due to its better signal-to-noise ratio. The non-contact sensor was then used to acquire in-vivo micro-CT images of a murine model for congenital diaphragmatic hernia and of 11-day-old mouse pups. In both cases, quality CT images were successfully acquired using this new respiration sensor. Despite the presence of beam hardening artefacts arising from the presence of a fibre-optic cable in the imaging field, we believe this new technique for respiration monitoring and gating presents an opportunity for in-vivo imaging of disease models which were previously considered too delicate for established animal handling methods.     

Prospective displacement and velocity-based cine 4D CT

Four dimensional (4D) computed tomography (CT) image sorting is currently a retrospective procedure. Mismatches in displacement and/or phase of a patient's respiratory signal, corresponding with two dimensional images taken at subsequent couch positions, become visible as artifacts in reconstructed 4D CT images. These artifacts appear as undefined or irregular boundaries in the 4D CT images and cause systematic errors in patient contouring and dose calculations. In addition, the substantially higher dose required for 4D CT, compared with 3D CT, is of concern. To minimize these problems, we developed a prospective respiratory displacement and velocity based cine 4D CT (PDV CT) method to trigger image acquisition if the displacement and velocity of the respiratory signal occurred within predetermined tolerances simultaneously. The use of velocity avoids real-time phase estimation. Real-time image acquisition ensures data sufficiency, while avoiding the need for redundant data. This may potentially result in a lower dose to the patient. PDV CT was compared with retrospective 4D CT acquisition methods, using respiratory signals of 24 lung cancer patients (103 sessions) under free breathing conditions. Image acquisition was simulated for each of these sessions from the respiratory signal. The root mean square (RMS) of differences between displacements and velocities of the respiratory signal corresponding to subsequent images was calculated in order to evaluate the image-sorting accuracy of each method. Patient dose reductions of 22 to 50% were achieved during image acquisition depending on the model parameters chosen. The mean RMS differences over all sessions and image bins show that PDV CT produces similar results to retrospective displacement sorting overall, although improvements of the RMS difference up to 20% were achieved depending on the model parameters chosen. Velocity RMS differences improved between 30 and 45% when compared with retrospective phase sorting. The efficiency in acquisition compared with retrospective phase sorting varied from approximately 10% for displacement and velocity tolerances of 1 mm and 4 mm/s, respectively, to 80 to 93% for 4 mm and 4 mm/s. The lower variation in the displacement and velocity of the respiratory signal in each image bin indicates that PDV CT could be a valuable tool for reducing artifacts in 4D CT images and lowering patient dose, although the cost may be increased acquisition time.     

Determination of prospective displacement-based gate threshold for respiratory-gated radiation delivery from retrospective phase-based gate threshold selected at 4D CT simulation

Four-dimensional (4D) computed tomography (CT) imaging has found increasing importance in the localization of tumor and surrounding normal structures throughout the respiratory cycle. Based on such tumor motion information, it is possible to identify the appropriate phase interval for respiratory gated treatment planning and delivery. Such a gating phase interval is determined retrospectively based on tumor motion from internal tumor displacement. However, respiratory-gated treatment is delivered prospectively based on motion determined predominantly from an external monitor. Therefore, the simulation gate threshold determined from the retrospective phase interval selected for gating at 4D CT simulation may not correspond to the delivery gate threshold that is determined from the prospective external monitor displacement at treatment delivery. The purpose of the present work is to establish a relationship between the thresholds for respiratory gating determined at CT simulation and treatment delivery, respectively. One hundred fifty external respiratory motion traces, from 90 patients, with and without audio-visual biofeedback, are analyzed. Two respiratory phase intervals, 40%-60% and 30%-70%, are chosen for respiratory gating from the 4D CT-derived tumor motion trajectory. From residual tumor displacements within each such gating phase interval, a simulation gate threshold is defined based on (a) the average and (b) the maximum respiratory displacement within the phase interval. The duty cycle for prospective gated delivery is estimated from the proportion of external monitor displacement data points within both the selected phase interval and the simulation gate threshold. The delivery gate threshold is then determined iteratively to match the above determined duty cycle. The magnitude of the difference between such gate thresholds determined at simulation and treatment delivery is quantified in each case. Phantom motion tests yielded coincidence of simulation and delivery gate thresholds to within 0.3%. For patient data analysis, differences between simulation and delivery gate thresholds are reported as a fraction of the total respiratory motion range. For the smaller phase interval, the differences between simulation and delivery gate thresholds are 8 +/- 11% and 14 +/- 21% with and without audio-visual biofeedback, respectively, when the simulation gate threshold is determined based on the mean respiratory displacement within the 40%-60% gating phase interval. For the longer phase interval, corresponding differences are 4 +/- 7% and 8 +/- 15% with and without audiovisual biofeedback, respectively. Alternatively, when the simulation gate threshold is determined based on the maximum average respiratory displacement within the gating phase interval, greater differences between simulation and delivery gate thresholds are observed. A relationship between retrospective simulation gate threshold and prospective delivery gate threshold for respiratory gating is established and validated for regular and nonregular respiratory motion. Using this relationship, the delivery gate threshold can be reliably estimated at the time of 4D CT simulation, thereby improving the accuracy and efficiency of respiratory-gated radiation delivery.     

Prospective respiratory-gated micro-CT of free breathing rodents

Microcomputed tomography (Micro-CT) has the potential to noninvasively image the structure of organs in rodent models with high spatial resolution and relatively short image acquisition times. However, motion artifacts associated with the normal respiratory motion of the animal may arise when imaging the abdomen or thorax. To reduce these artifacts and the accompanying loss of spatial resolution, we propose a prospective respiratory gating technique for use with anaesthetized, free-breathing rodents. A custom-made bed with an embedded pressure chamber was connected to a pressure transducer. Anaesthetized animals were placed in the prone position on the bed with their abdomens located over the chamber. During inspiration, the motion of the diaphragm caused an increase in the chamber pressure, which was converted into a voltage signal by the transducer. An output voltage was used to trigger image acquisition at any desired time point in the respiratory cycle. Digital radiographic images were acquired of anaesthetized, free-breathing rats with a digital radiographic system to correlate the respiratory wave form with respiration-induced organ motion. The respiratory wave form was monitored and recorded simultaneously with the x-ray radiation pulses, and an imaging window was defined, beginning at end expiration. Phantom experiments were performed to verify that the respiratory gating apparatus was triggering the micro-CT system. Attached to the distensible phantom were 100 microm diameter copper wires and the measured full width at half maximum was used to assess differences in image quality between respiratory-gated and ungated imaging protocols. This experiment allowed us to quantify the improvement in the spatial resolution, and the reduction of motion artifacts caused by moving structures, in the images resulting from respiratory-gated image acquisitions. The measured wire diameters were 0.135 mm for the stationary phantom image, 0.137 mm for the image gated at end deflation, 0.213 mm for the image gated at peak inflation, and 0.406 mm for the ungated image. Micro-CT images of anaesthetized, free-breathing rats were acquired with a General Electric Healthcare eXplore RS in vivo micro-CT system. Images of the thorax were acquired using the respiratory cycle-based trigger for the respiratory-gated mode. Respiratory gated-images were acquired at inspiration and end expiration, during a period of minimal respiration-induced organ motion. Gated images were acquired with a nominal isotropic voxel spacing of 44 microm in 20-25 min (80 kVp, 113 mAs, 300 ms imaging window per projection). The equivalent ungated acquisitions were 11 min in length. We observed improved definition of the diaphragm boundary and increased conspicuity of small structures within the lungs in the gated images, when compared to the ungated acquisitions. In this work, we have characterized the externally monitored respiratory wave form of free-breathing, anaesthetized rats and correlated the respiration-induced organ motion to the respiratory cycle. We have shown that the respiratory pressure wave form is an excellent surrogate for the radiographic organ motion. This information facilitates the definition of an imaging window at any phase of the breathing cycle. This approach for prospectively gated micro-CT can provide high quality images of anaesthetized free-breathing rodents.     

A radial sampling strategy for uniform k‐space coverage with retrospective respiratory gating in 3D ultrashort‐echo‐time lung imaging

The purpose of this work was to develop a 3D radial‐sampling strategy which maintains uniform k‐space sample density after retrospective respiratory gating, and demonstrate its feasibility in free‐breathing ultrashort‐echo‐time lung MRI. A multi‐shot, interleaved 3D radial sampling function was designed by segmenting a single‐shot trajectory of projection views such that each interleaf samples k‐space in an incoherent fashion. An optimal segmentation factor for the interleaved acquisition was derived based on an approximate model of respiratory patterns such that radial interleaves are evenly accepted during the retrospective gating. The optimality of the proposed sampling scheme was tested by numerical simulations and phantom experiments using human respiratory waveforms. Retrospectively, respiratory‐gated, free‐breathing lung MRI with the proposed sampling strategy was performed in healthy subjects. The simulation yielded the most uniform k‐space sample density with the optimal segmentation factor, as evidenced by the smallest standard deviation of the number of neighboring samples as well as minimal side‐lobe energy in the point spread function. The optimality of the proposed scheme was also confirmed by minimal image artifacts in phantom images. Human lung images showed that the proposed sampling scheme significantly reduced streak and ring artifacts compared with the conventional retrospective respiratory gating while suppressing motion‐related blurring compared with full sampling without respiratory gating. In conclusion, the proposed 3D radial‐sampling scheme can effectively suppress the image artifacts due to non‐uniform k‐space sample density in retrospectively respiratory‐gated lung MRI by uniformly distributing gated radial views across the k‐space. Copyright © 2016 John Wiley & Sons, Ltd.     

Extraction of the respiratory signal from small-animal CT projections for a retrospective gating method

We propose a retrospective respiratory gating algorithm to generate dynamic CT studies. To this end, we compared three different methods of extracting the respiratory signal from the projections of small-animal cone-beam computed tomography (CBCT) scanners. Given a set of frames acquired from a certain axial angle, subtraction of their average image from each individual frame produces a set of difference images. Pixels in these images have positive or negative values (according to the respiratory phase) in those areas where there is lung movement. The respiratory signals were extracted by analysing the shape of the histogram of these difference images: we calculated the first four central and non-central moments. However, only odd-order moments produced the desired breathing signal, as the even-order moments lacked information about the phase. Each of these curves was compared to a reference signal recorded by means of a pneumatic pillow. Given the similar correlation coefficients yielded by all of them, we selected the mean to implement our retrospective protocol. Respiratory phase bins were separated, reconstructed independently and included in a dynamic sequence, suitable for cine playback. We validated our method in five adult rat studies by comparing profiles drawn across the diaphragm dome, with and without retrospective respiratory gating. Results showed a sharper transition in the gated reconstruction, with an average slope improvement of 60.7%.     

Software-based respiratory gating for small animal conebeam CT

In volumetric CT imaging of small animals, the breathing motion of the lungs during the image acquisition process results in inconsistent projection data being acquired. When reconstructed, these inconsistent data may produce images with reduced spatial resolution and image contrast. In order to minimize these effects, various approaches have been utilized to capture the respiratory signal of the animals under study and to only obtain CT data at specific moments in the respiratory cycle. These approaches typically utilize hardware-based physiological monitoring equipment in order to record the respiratory signal and either prospectively or retrospectively correlate this signal with acquired CT projection data. In this work, a new method of CT respiratory gating is described that does not rely on external physiological monitoring. Rather, determination of the respiratory phase of the animal is performed by postprocessing the acquired projection data. With this approach, any CT projection data can be respiratory gated with minimal effort. Validation of the method has been performed using a dynamic phantom and accuracy in tidal volumes determined to be within 16%. Rats and mice have been scanned and processed using the proposed method and compared to physiological-based measurement. With the proposed method, image quality is significantly improved in addition to providing quantitative information regarding tidal lung volumes.     

Cardiac computed tomography using redundant-ray prospective gating

A fourth-generation, computed tomographic (CT) scanner, equipped for prospectively gated cardiac imaging, was modified to control the scan data acquisition by using knowledge of the location of redundant rays in the sinogram. In conventional prospective gating, a computer monitors the electrocardiogram (ECG) and calculates when to initiate the next scan in a gated series in order to acquire all 360 degrees of projection data for a desired phase of the cardiac cycle. However, in each scan of a series, every projection ray is measured twice (when the positions of the source and detector are reversed). Redundant-ray prospective gating takes advantage of this information to improve the efficiency of data acquisition. Using a heart phantom "beating" at 90 min-1, images of all phases of the cardiac cycle with 100-ms temporal resolution were obtained in four scans with redundant-ray gating; whereas a four-scan series with conventional prospective gating yielded worse images of 170-ms resolution.     

Four-dimensional (4D) PET/CT imaging of the thorax

We have reported in our previous studies on the methodology, and feasibility of 4D-PET (Gated PET) acquisition, to reduce respiratory motion artifact in PET imaging of the thorax. In this study, we expand our investigation to address the problem of respiration motion in PET/CT imaging. The respiratory motion of four lung cancer patients were monitored by tracking external markers placed on the thorax. A 4D-CT acquisition was performed using a "step-and-shoot" technique, in which computed tomography (CT) projection data were acquired over a complete respiratory cycle at each couch position. The period of each CT acquisition segment was time stamped with an "x-ray ON" signal, which was recorded by the tracking system. 4D-CT data were then sorted into 10 groups, according to their corresponding phase of the breathing cycle. 4D-PET data were acquired in the gated mode, where each breathing cycle was divided into ten 0.5 s bins. For both CT and PET acquisitions, patients received audio prompting to regularize breathing. The 4D-CT and 4D-PET data were then correlated according to respiratory phase. The effect of 4D acquisition on improving the co-registration of PET and CT images, reducing motion smearing, and consequently increase the quantitation of the SUV, were investigated. Also, quantitation of the tumor motions in PET, and CT, were studied and compared. 4D-PET with matching phase 4D-CTAC showed an improved accuracy in PET-CT image co-registration of up to 41%, compared to measurements from 4D-PET with clinical-CTAC. Gating PET data in correlation with respiratory motion reduced motion-induced smearing, thereby decreasing the observed tumor volume, by as much as 43%. 4D-PET lesions volumes showed a maximum deviation of 19% between clinical CT and phase- matched 4D-CT attenuation corrected PET images. In CT, 4D acquisition resulted in increasing the tumor volume in two patients by up to 79%, and decreasing it in the other two by up to 35%. Consequently, these corrections have yielded an increase in the measured SUV by up to 16% over the clinical measured SUV, and 36% over SUV's measured in 4D-PET with clinical-CT Attenuation Correction (CTAC) SUV's. Quantitation of the maximum tumor motion amplitude, using 4D-PET and 4D-CT, showed up to 30% discrepancy between the two modalities. We have shown that 4D PET/CT is clinically a feasible method, to correct for respiratory motion artifacts in PET/CT imaging of the thorax. 4D PET/CT acquisition can reduce smearing, improve the accuracy in PET-CT co-registration, and increase the measured SUV. This should result in an improved tumor assessment for patients with lung malignancies.     

Comparison of 2D, 3D high dose and 3D low dose gated myocardial 82Rb PET imaging

Background

We compared 2D, 3D high dose (HD) and 3D low dose (LD) gated myocardial Rb-82 PET imaging in 16 normal human studies. The main goal in the paper is to evaluate whether the images obtained by a 3D LD studies are still of comparable clinical quality to the images obtained with the 2D HD or 3D HD studies.

Methods

All 2D and 3D HD studies were performed with 2220 MBq of Rb-82. The 3D LD were performed with 740 MBq of Rb-82. A GE Advance PET system was used for acquisition. Polar maps were created and used to calculate noise among (NAS) and within (NWS) the segments in the noise analysis. In addition, the contrast between left ventricular (LV) wall and LV cavity was also analysed. For 13 subjects, ejection fraction (EF) on 2D and 3D studies was calculated using QGS program.

Results

For the H20 reconstruction filter, the mean contrast in mid-ventricular short-axis slice was 0.33 ± 0.06 for 2D studies. The same contrast for the 3D HD studies was 0.38 ± 0.07 and for 3D LD, it was 0.34 ± 0.08. For the 6 volunteers where 3D HD was used, NAS was 3.64*10^-4 and NWS was 1.79*10^-2 for 2D studies, and NAS was 3.70*10^-4 and NWS was 1.85*10^-2 for 3D HD studies, respectively. For the other 10 volunteers where 3D LD was used, NAS was 3.85*10^-4 and NWS was 1.82*10^-2 for the 2D studies, and NAS was 5.58*10^-4 and NWS was 1.91*10^-2 for the 3D LD studies, respectively. For the sharper H13 filter, the data followed the same pattern, with slightly higher values of contrast and noise. EF values in 2D and 3D were close. The Pearson's correlation coefficient was 0.90. The average difference from 13 subjects was 8.3%.

Conclusion

2D and 3D HD gating Rb-82 PET cardiac studies have similar contrast, ejection fractions and noise levels. 3D LD gating imaging, gave comparable results in terms of contrast, EF and noise to either 2D or 3D HD gating PET imaging. 3D LD PET gated imaging can make Rb-82 PET cardiac imaging more affordable with significantly less radiation exposure to the patients.     

Robust fluoroscopic respiratory gating for lung cancer radiotherapy without implanted fiducial markers

For gated lung cancer radiotherapy, it is difficult to generate accurate gating signals due to the large uncertainties when using external surrogates and the risk of pneumothorax when using implanted fiducial markers. We have previously investigated and demonstrated the feasibility of generating gating signals using the correlation scores between the reference template image and the fluoroscopic images acquired during the treatment. In this paper, we present an in-depth study, aiming at the improvement of robustness of the algorithm and its validation using multiple sets of patient data. Three different template generating and matching methods have been developed and evaluated: (1) single template method, (2) multiple template method, and (3) template clustering method. Using the fluoroscopic data acquired during patient setup before each fraction of treatment, reference templates are built that represent the tumour position and shape in the gating window, which is assumed to be at the end-of-exhale phase. For the single template method, all the setup images within the gating window are averaged to generate a composite template. For the multiple template method, each setup image in the gating window is considered as a reference template and used to generate an ensemble of correlation scores. All the scores are then combined to generate the gating signal. For the template clustering method, clustering (grouping of similar objects together) is performed to reduce the large number of reference templates into a few representative ones. Each of these methods has been evaluated against the reference gating signal as manually determined by a radiation oncologist. Five patient datasets were used for evaluation. In each case, gated treatments were simulated at both 35% and 50% duty cycles. False positive, negative and total error rates were computed. Experiments show that the single template method is sensitive to noise; the multiple template and clustering methods are more robust to noise due to the smoothing effect of aggregation of correlation scores; and the clustering method results in the best performance in terms of computational efficiency and accuracy.     

A novel method for incorporating respiratory-matched attenuation correction in the motion correction of cardiac PET-CT studies

Mismatches between PET and CT datasets due to respiratory effects can lead to artefactual perfusion defects. To overcome this, we have proposed a method of aligning a single CT with each frame of a gated PET study in a semi-automatic manner, incorporating a statistical shape model of the diaphragm and a rigid registration of the heart. This ensures that the structures that could influence the appearance of the reconstructed cardiac activity are correctly matched between emission and transmission datasets. When tested on two patient studies, it was found in both cases that attenuation correction using the proposed technique resulted in PET images that were closer to the gold standard of attenuation correction with a gated CT, compared with scenarios where only heart matching was considered (and not the diaphragm) or where no transformation was performed (i.e. where a single CT frame was used to attenuation-correct all PET frames). These preliminary results suggest that diaphragm matching between PET and CT improves the quantitative accuracy of reconstructed PET images and that the proposed method of using a statistical shape model to describe the diaphragm shape and motion, in combination with a rigid registration to determine respiratory-induced heart motion, is a feasible method of achieving this.