8/7/2017. Disclosures. MECT Systems Overview and Quantitative Opportunities. Overview. Computed Tomography (CT) CT Numbers. Polyenergetic Acquisition

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1 Quantitative Multi-Energy Computed Tomography: Imaging and Therapy Advancements Disclosures MECT Systems Overview and Quantitative Opportunities The speaker receives research funding from GE Healthcare Taly Gilat Schmidt, PhD Associate Professor Department of Biomedical Engineering Marquette University & Medical College of Wisconsin Overview Computed Tomography (CT) Why multi-energy? Important considerations in multi-energy acquisition Overview of clinical multi-energy acquisition approaches Introduction to multi-energy processing approaches What does each gray level represent? CT Numbers Polyenergetic Acquisition Pixel values (CT numbers) are in Hounsfield Units (HU) Hounsfield Units represents x-ray attenuation of the material X-ray attenuation depends on material properties Density Atomic # X-ray attenuation depends on energy CT data is acquired with a polyenergetic x-ray spectrum Conventional detectors integrate the detected signal over energy Energy-dependent information is lost HU represents the effective X-ray attenuation coefficient I o (E) x Energy () 1

2 Lost Spectral Information Hemorrhage or Retained Iodine? Different materials may have same HU value in the reconstructed image - ex. Calcium and Iodine Can t distinguish between changes in material density and changes in material composition The reconstructed HU value depends on the thickness of the material - Beam hardening artifacts C.M. Phan et al. AJNR Am J Neuroradiol 1;33: by American Society of Neuroradiology Gout or Pseudo-Gout? Madhura A. Desai; Jeffrey J. Peterson; Hillary Warren Garner; Mark J. Kransdorf; RadioGraphics 11, 31, DOI: 1.11/rg RSNA, 11 X-ray Attenuation & Material Decomposition X-ray attenuation occurs through primarily two processes in the CT energy range Compton Scatter Different Energy / Photoelectric Absorption Material Dependency Separate the effects of material composition and density unknowns We can solve for (a,b) if we have x-ray measurements at two energies Another Way to Understand Material Decomposition Materials with higher atomic number have a greater change of x-ray attenuation with energy Another Way to Understand Material Decomposition Materials with higher atomic number have a greater change of x-ray attenuation with energy By acquiring CT at two energies, we can measure the change in attenuation with energy Can discern changes in attenuation due to atomic number versus density kv muscle calcium adipose uric acid 1 kv iodine Slope represents material composition Distance from origin represents density

3 Multi-Energy Acquisition CT systems can acquire CT data using two spectra High energy, low energy Methods differ across manufacturers x kv 1 kv Energy () x kv 1 kv Energy () Johnson, AJR S3-S, 1 Beam filtration reduces overlap between the two spectra Optimized dose allocation reduces noise Johnson, AJR S3-S, 1 x kv 1 kv Energy () Optimized dose allocation reduces noise Reduced time between two spectral measurements reduces artifacts - Motion artifacts - Contrast enhancement - Beam hardening artifacts (raw data processing) Optimized dose allocation reduces noise Reduced time between two spectral measurements reduces artifacts Motion artifacts, Beam hardening artifacts (raw data processing) Workflow considerations x kv 1 kv Energy () 3

4 Sequential Dual-kV Acquisition Sequential Dual-kV Acquisition Complete helical scan is first performed at low kv, followed by high kv kv, ma, pitch can be modified between the two scans Images are registered after reconstruction Additional filtration possible, but not implemented Can be optimized by ma selection, pitch ~ Seconds Adds dual energy acquisition to existing scanners Layered Detector (Philips) Acquisition kv alternates for over each gantry rotation Tube turned off during anterior views ma can be adjusted between views matomsessions/index.php/dual-energyspectral-ct-more-precisely-defined/ Acquisition Additional spectral filtration possible, but not implemented Optimized by ma selection Gantry rotation time (~.5 seconds)

5 Fast kv Switching Alternates between low and high kv between projections Tube current cannot rapidly modified Instead, dwell time increased for low kv Fast kv Switching Acquisition Integration time < 1 ms Raw data processing possible Dual-Source Acquisition Dual-source system operates with the two sources at different kv, and ma settings Filter can be added to highkv gantry matomsessions/index.php/dual-energyspectral-ct-more-precisely-defined/ Acquisition Additional spectral filtration ma selection ¼ gantry rotation (~1 ms) Increased scatter due to dual x-ray beam Layered Detector (Philips) 5

6 Dual-Layer Detector Acquisition Dual-Layer Detector Acquisition Detector is composed of two layers Top layer is low-density scintillator, sensitive to lowenergy photons Bottom layer is high-density scintillator sensitive to highenergy photons yttrium-based garnet scintillator global/explore/white-papers/ct/detectortechnology-in-simultaneous-spectral-imaging Detector layer material, thickness Can t be optimized Simultaneous acquisition Dual-energy acquired as part of routine scan Layered Detector (Philips) Photon-counting Detector (under development) Photon-Counting Detector Acquisition Direct-conversion semiconductor detectors perform pulseheight analysis to acquire spectral information Pulse proportional to deposited energy CZT, CdTe, Si E Readout Electronics T T3 T +1 T1 +1 Photon-Counting Detector Acquisition Comparison: Detector spectral response Threshold settings Simultaneous acquisition Raw data processing possible + spectral measurements Acquired as part of routine scan Faby et al. Med. Phys. 15;: 39 3 Increasing

7 Comparison: Increasing delay between measurements sec < 1 ms < 1 ms ~.5 sec > 1 sec Multi-Energy Data Processing Blend high and low energy images to create CT image with improved contrast/noise Material Separation Material Decomposition: Effective Z, density images Effective monoenergetic images kv muscle calcium adipose uric acid 1 kv iodine Slope represents material composition Distance from origin represents density Hemorrhage or Retained Iodine? Gout or Pseudo-Gout? C.M. Phan et al. AJNR Am J Neuroradiol 1;33: by American Society of Neuroradiology Madhura A. Desai; Jeffrey J. Peterson; Hillary Warren Garner; Mark J. Kransdorf; RadioGraphics 11, 31, DOI: 1.11/rg RSNA, 11 What about dose? Depends on the application Must compare multi-energy and conventional CT protocols at equivalent image quality, optimized for the application Studies have demonstrated dual-energy dose neutrality for some applications [Henzler et. al, AJR, 1] Conclusions Multi-energy CT separates the effects of material composition and material density Enables separating materials that are indistinguishable on conventional CT images Vendors have different approaches for multi energy imaging with different advantages and disadvantages 7

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