Purpose: Design and optimization of medical imaging systems benefit from accurate theoretical modeling that identifies the physical factors governing image quality, particularly in the early stages of system development. This work extends Fourier metrics of imaging performance and detectability index ͑dЈ͒ to tomosynthesis and cone-beam CT ͑CBCT͒ and investigates the extent to which dЈ is a valid descriptor of task-based imaging performance as assessed by human observers. Methods:The detectability index for tasks presented in 2D slices ͑d slice Ј ͒ was derived from 3D cascaded systems analysis of tomosynthesis and CBCT. Anatomical background noise measured in a physical phantom presenting power-law spectral density was incorporated in the "generalized" noise-equivalent quanta. Theoretical calculations of d slice Ј were performed as a function of total angular extent ͑ tot ͒ of source-detector orbit ranging 10°-360°under two acquisition schemes: ͑i͒ Constant angular separation between projections ͑constant-⌬͒, giving variable number of projections ͑N proj ͒ and dose vs tot and ͑ii͒ constant number of projections ͑constant-N proj ͒, giving constant dose ͑but variable angular sampling͒ with tot . Five simple observer models were investigated: Prewhitening ͑PW͒, prewhitening with eye filter and internal noise ͑PWEi͒, nonprewhitening ͑NPW͒, nonprewhitening with eye filter ͑NPWE͒, and nonprewhitening with eye filter and internal noise ͑NPWEi͒. Human observer performance was measured in 9AFC tests for five simple imaging tasks presented within uniform and power-law clutter backgrounds. Measurements ͑from 9AFC tests͒ and theoretical calculations ͑from cascaded systems analysis of d slice Ј ͒ were compared in terms of area under the ROC curve ͑A z ͒ Results: Reasonable correspondence between theoretical calculations and human observer performance was achieved for all imaging tasks over the broad range of experimental conditions and acquisition schemes. The PW and PWEi observer models tended to overestimate detectability, while the various NPW models predicted observer performance fairly well, with NPWEi giving the best overall agreement. Detectability was shown to increase with tot due to the reduction of out-of-plane clutter, reaching a plateau after a particular tot that depended on the imaging task. Depending on the acquisition scheme, however ͑i.e., constant-N proj or ⌬͒, detectability was seen in some cases to decline at higher tot due to tradeoffs among quantum noise, background clutter, and view sampling. Conclusions: Generalized detectability index derived from a 3D cascaded systems model shows reasonable correspondence with human observer performance over a fairly broad range of imaging tasks and conditions, although discrepancies were observed in cases relating to orbits intermediate to 180°and 360°. The basic correspondence of theoretical and measured performance supports the 1754 1754 Med. Phys. 38 "4…,

Traditional space-invariant regularization methods in tomographic image reconstruction using penalized-likelihood estimators produce images with nonuniform spatial resolution properties. The local point spread functions that quantify the smoothing properties of such estimators are space-variant, asymmetric, and object-dependent even for space-invariant imaging systems. We propose a new quadratic regularization scheme for tomographic imaging systems that yields increased spatial uniformity and is motivated by the least-squares fitting of a parameterized local impulse response to a desired global response. We have developed computationally efficient methods for PET systems with shift-invariant geometric responses. We demonstrate the increased spatial uniformity of this new method versus conventional quadratic regularization schemes in simulated PET thorax scans.

A dedicated extremity cone-beam CT scanner capable of imaging upper and lower extremities (including weight-bearing examinations) provides sufficient image quality and favorable dose characteristics to warrant further evaluation for clinical use.

Purpose:The proliferation of cone-beam CT (CBCT) has created interest in performance optimization, with x-ray scatter identified among the main limitations to image quality. CBCT often contends with elevated scatter, but the wide variety of imaging geometry in different CBCT configurations suggests that not all configurations are affected to the same extent. Graphics processing unit (GPU) accelerated Monte Carlo (MC) simulations are employed over a range of imaging geometries to elucidate the factors governing scatter characteristics, efficacy of antiscatter grids, guide system design, and augment development of scatter correction. Methods: A MC x-ray simulator implemented on GPU was accelerated by inclusion of variance reduction techniques (interaction splitting, forced scattering, and forced detection) and extended to include x-ray spectra and analytical models of antiscatter grids and flat-panel detectors. The simulator was applied to small animal (SA), musculoskeletal (MSK) extremity, otolaryngology (Head), breast, interventional C-arm, and on-board (kilovoltage) linear accelerator (Linac) imaging, with an axis-todetector distance (ADD) of 5, 12, 22, 32, 60, and 50 cm, respectively. Each configuration was modeled with and without an antiscatter grid and with (i) an elliptical cylinder varying 70-280 mm in major axis; and (ii) digital murine and anthropomorphic models. The effects of scatter were evaluated in terms of the angular distribution of scatter incident upon the detector, scatter-to-primary ratio (SPR), artifact magnitude, contrast, contrast-to-noise ratio (CNR), and visual assessment. Results: Variance reduction yielded improvements in MC simulation efficiency ranging from ∼17-fold (for SA CBCT) to ∼35-fold (for Head and C-arm), with the most significant acceleration due to interaction splitting (∼6 to ∼10-fold increase in efficiency). The benefit of a more extended geometry was evident by virtue of a larger air gap-e.g., for a 16 cm diameter object, the SPR reduced from 1.5 for ADD = 12 cm (MSK geometry) to 1.1 for ADD = 22 cm (Head) and to 0.5 for ADD = 60 cm (C-arm). Grid efficiency was higher for configurations with shorter air gap due to a broader angular distribution of scattered photons-e.g., scatter rejection factor ∼0.8 for MSK geometry versus ∼0.65 for C-arm. Grids reduced cupping for all configurations but had limited improvement on scatterinduced streaks and resulted in a loss of CNR for the SA, Breast, and C-arm. Relative contribution of forward-directed scatter increased with a grid (e.g., Rayleigh scatter fraction increasing from ∼0.15 without a grid to ∼0.25 with a grid for the MSK configuration), resulting in scatter distributions with greater spatial variation (the form of which depended on grid orientation). Conclusions: A fast MC simulator combining GPU acceleration with variance reduction provided a systematic examination of a range of CBCT configurations in relation to scatter, highlighting the magnitude and spatial uniformity of individual scatter components, illustrating trad...

Purpose: Nonstationarity is an important aspect of imaging performance in CT and cone-beam CT (CBCT), especially for systems employing iterative reconstruction. This work presents a theoretical framework for both filtered-backprojection (FBP) and penalized-likelihood (PL) reconstruction that includes explicit descriptions of nonstationary noise, spatial resolution, and task-based detectability index. Potential utility of the model was demonstrated in the optimal selection of regularization parameters in PL reconstruction. Methods: Analytical models for local modulation transfer function (MTF) and noise-power spectrum (NPS) were investigated for both FBP and PL reconstruction, including explicit dependence on the object and spatial location. For FBP, a cascaded systems analysis framework was adapted to account for nonstationarity by separately calculating fluence and system gains for each ray passing through any given voxel. For PL, the point-spread function and covariance were derived using the implicit function theorem and first-order Taylor expansion according to Fessler ["Mean and variance of implicitly defined biased estimators (such as penalized maximum likelihood): Applications to tomography," IEEE Trans. Image Process. 5(3), 493-506 (1996)]. Detectability index was calculated for a variety of simple tasks. The model for PL was used in selecting the regularization strength parameter to optimize task-based performance, with both a constant and a spatially varying regularization map. Results: Theoretical models of FBP and PL were validated in 2D simulated fan-beam data and found to yield accurate predictions of local MTF and NPS as a function of the object and the spatial location. The NPS for both FBP and PL exhibit similar anisotropic nature depending on the pathlength (and therefore, the object and spatial location within the object) traversed by each ray, with the PL NPS experiencing greater smoothing along directions with higher noise. The MTF of FBP is isotropic and independent of location to a first order approximation, whereas the MTF of PL is anisotropic in a manner complementary to the NPS. Task-based detectability demonstrates dependence on the task, object, spatial location, and smoothing parameters. A spatially varying regularization "map" designed from locally optimal regularization can improve overall detectability beyond that achievable with the commonly used constant regularization parameter. Conclusions: Analytical models for task-based FBP and PL reconstruction are predictive of nonstationary noise and resolution characteristics, providing a valuable framework for understanding and optimizing system performance in CT and CBCT.

We present a framework for robustly estimating registration between a 3D volume image and a 2D projection image and evaluate its precision and robustness in spine interventions for vertebral localization in the presence of anatomical deformation. The framework employs a normalized gradient information similarity metric and multi-start covariance matrix adaptation evolution strategy optimization with local-restarts, which provided improved robustness against deformation and content mismatch. The parallelized implementation allowed orders-of-magnitude acceleration in computation time and improved the robustness of registration via multi-start global optimization. Experiments involved a cadaver specimen and two CT datasets (supine and prone) and 36 C-arm fluoroscopy images acquired with the specimen in four positions (supine, prone, supine with lordosis, prone with kyphosis), three regions (thoracic, abdominal, and lumbar), and three levels of geometric magnification (1.7, 2.0, 2.4). Registration accuracy was evaluated in terms of projection distance error (PDE) between the estimated and true target points in the projection image, including 14 400 random trials (200 trials on the 72 registration scenarios) with initialization error up to ±200 mm and ±10°. The resulting median PDE was better than 0.1 mm in all cases, depending somewhat on the resolution of input CT and fluoroscopy images. The cadaver experiments illustrated the tradeoff between robustness and computation time, yielding a success rate of 99.993% in vertebral labeling (with `success' defined as PDE <5 mm) using 1,718 664 ± 96 582 function evaluations computed in 54.0 ± 3.5 s on a mid-range GPU (nVidia, GeForce GTX690). Parameters yielding a faster search (e.g., fewer multi-starts) reduced robustness under conditions of large deformation and poor initialization (99.535% success for the same data registered in 13.1 s), but given good initialization (e.g., ±5 mm, assuming a robust initial run) the same registration could be solved with 99 993% success in 6.3 s. The ability to register CT to fluoroscopy in a manner robust to patient deformation could be valuable in applications such as radiation therapy, interventional radiology, and an assistant to target localization (e.g., vertebral labeling) in image-guided spine surgery.

Purpose: This paper reports on the design and initial imaging performance of a dedicated conebeam CT (CBCT) system for musculoskeletal (MSK) extremities. The system complements conventional CT and MR and offers a variety of potential clinical and logistical advantages that are likely to be of benefit to diagnosis, treatment planning, and assessment of therapy response in MSK radiology, orthopaedic surgery, and rheumatology. Methods: The scanner design incorporated a host of clinical requirements (e.g., ability to scan the weight-bearing knee in a natural stance) and was guided by theoretical and experimental analysis of image quality and dose. Such criteria identified the following basic scanner components and system configuration: a flat-panel detector (FPD, Varian 3030þ, 0.194 mm pixels); and a low-power, fixed anode x-ray source with 0.5 mm focal spot (SourceRay XRS-125-7K-P, 0.875 kW) mounted on a retractable C-arm allowing for two scanning orientations with the capability for side entry, viz. a standing configuration for imaging of weight-bearing lower extremities and a sitting configuration for imaging of tensioned upper extremity and unloaded lower extremity. Theoretical modeling employed cascaded systems analysis of modulation transfer function (MTF) and detective quantum efficiency (DQE) computed as a function of system geometry, kVp and filtration, dose, source power, etc. Physical experimentation utilized an imaging bench simulating the scanner geometry for verification of theoretical results and investigation of other factors, such as antiscatter grid selection and 3D image quality in phantom and cadaver, including qualitative comparison to conventional CT. Results: Theoretical modeling and benchtop experimentation confirmed the basic suitability of the FPD and x-ray source mentioned above. Clinical requirements combined with analysis of MTF and DQE yielded the following system geometry: a $55 cm source-to-detector distance; 1.3 magnification; a 20 cm diameter bore (20 Â 20 Â 20 cm 3 field of view); total acquisition arc of $240 . The system MTF declines to 50% at $1.3 mm À1 and to 10% at $2.7 mm À1, consistent with submillimeter spatial resolution. Analysis of DQE suggested a nominal technique of 90 kVp (þ0.3 mm Cu added filtration) to provide high imaging performance from $500 projections at less than $0.5 kW power, implying $6.4 mGy (0.064 mSv) for low-dose protocols and $15 mGy (0.15 mSv) for high-quality protocols. The experimental studies show improved image uniformity and contrast-tonoise ratio (without increase in dose) through incorporation of a custom 10:1 GR antiscatter grid. Cadaver images demonstrate exquisite bone detail, visualization of articular morphology, and softtissue visibility comparable to diagnostic CT (10-20 HU contrast resolution). Conclusions:The results indicate that the proposed system will deliver volumetric images of the extremities with soft-tissue contrast resolution comparable to diagnostic CT and improved spatial resolution at potentially reduced dose. Cascaded sys...

CT is the frontline imaging modality for diagnosis of acute traumatic brain injury (TBI), involving the detection of fresh blood in the brain (contrast of 30-50 HU, detail size down to 1 mm) in a non-contrast-enhanced exam. A dedicated point-of-care imaging system based on cone-beam CT (CBCT) could benefit early detection of TBI and improve direction to appropriate therapy. However, flat-panel detector (FPD) CBCT is challenged by artifacts that degrade contrast resolution and limit application in soft-tissue imaging. We present and evaluate a fairly comprehensive framework for artifact correction to enable soft-tissue brain imaging with FPD CBCT. The framework includes a fast Monte Carlo (MC)-based scatter estimation method complemented by corrections for detector lag, veiling glare, and beam hardening.The fast MC scatter estimation combines GPU acceleration, variance reduction, and simulation with a low number of photon histories and reduced number of projection angles (sparse MC) augmented by kernel de-noising to yield a runtime of ~4 min per scan. Scatter correction is combined with two-pass beam hardening correction. Detector lag correction is based on temporal deconvolution of the measured lag response function. The effects of detector veiling glare are reduced by deconvolution of the glare response function representing the long range tails of the detector point-spread function. The performance of the correction framework is quantified in experiments using a realistic head phantom on a testbench for FPD CBCT.Uncorrected reconstructions were non-diagnostic for soft-tissue imaging tasks in the brain. After processing with the artifact correction framework, image uniformity was substantially improved, and artifacts were reduced to a level that enabled visualization of ~3 mm simulated bleeds throughout the brain. Non-uniformity (cupping) was reduced by a factor of 5, and contrast of simulated bleeds was improved from ~7 to 49.7 HU, in good agreement with the nominal blood contrast of 50 HU. Although noise was amplified by the corrections, the contrast-to-noise ratio (CNR) of simulated bleeds was improved by nearly a factor of 3.5 (CNR = 0.54 without corrections and 1.91 after correction). The resulting image quality motivates further development and translation of the FPD-CBCT system for imaging of acute TBI.