基于Cone Beam CT图像的呼吸运动分析

呼吸运动是有一定规律性的运动,传统呼吸运动模型用公式描述,不能准确反映不同病人的特点或同一病人不同时期的特点,无法满足实时准确分析的需要。为此,我们提出了一种通过跟踪病人自由呼吸状态下所采集的Cone Beam CT图像序列中的横隔膜的运动来建立病人呼吸运动模型的方法。该方法建立的模型与传统的呼吸运动理论模型非常相似,证明了它是可行且有效的,同时该方法更能实时准确地反映病人的呼吸运动规律,具有很高的临床实用价值。

Analytical Calculation of the Compton Single Scatter Component of Pencil Beam Scatter Kernel for Scatter Correction in kV Cone Beam CT (kV-CBCT)

The accuracy of conventional superposition or convolution methods for scatter correction in kV-CBCT is usually compromised by the spatial variation of pencil-beam scatter kernel (PBSK) due to finite size, irregular external contour and heterogeneity of the imaged object. This study aims to propose an analytical method to quantify the Compton single scatter (CSS) component of the PBSK, which dominates the spatial distribution of total scatter assuming that multiple scatter can be estimated as a constant background and Rayleigh scatter is the secondary source of scatter. The CSS component of PBSK is the line integration of scatter production by incident primary photons along the beam line followed by the post-scattering attenuation as the scattered photons traverse the object. We propose to separate the object-specific attenuation term from the line integration and equivalently replace it with an average value such that the line integration of scatter production is object independent but only beam specific. We derived a quartic function formula as an approximate solution to the spatial distribution of the unattenuated CSS component of PBSK. The “effective scattering center” is introduced to calculate the average attenuation. The proposed analytical framework to calculate the CSS was evaluated using parameter settings of the On-Board Imager kV-CBCT system and was found to be in high agreement with the reference results. The proposed method shows highly increased computational efficiency compared to conventional analytical calculation methods based on point scattering model. It is also potentially useful for correcting the spatial variant PBSK in adaptive superposition method.

Clinical Significance of Pathological and Anatomical Findings in Cone Beam CT Scans of the Maxillary Sinus

Objective: To determine the range and prevalence of pathological conditions and demonstration of significant anatomical structures in the maxillary sinuses using the cone beam computerized tomographic (CBCT) scan. Methodology: Case series of 60 CBCT scans of the maxillae. Results: Forty (67%) of the scans were of female patients while the rest (20, 33%) were of males. Remarkably, the majority of the scans were requested for those patients who sought dental implant fabrication. Overall, 35 (58%) scans demonstrated pathological features while 8 (13%) demonstrated significant anatomical structures. Pathological features included mucosal thickening in 26 (43%), polypoid lesions in 9 (15%), total antral opacification in 1 (2%) and foreign body in 1 (2%). The commonest anatomic feature was dental root protrusion into the maxillary sinuses in 8 (13%). Conclusion: The CBCT imaging is an important tool for investigating the maxillary sinuses for pathology and the demonstration of the associated anatomic relations.

Image quality of cone beam CT on respiratory motion

In this study,the influence of respiratory motion on Cone Beam CT (CBCT) image quality was investigated by a motion simulating platform,an image quality phantom,and a kV X-ray CBCT.A total of 21 motion states in the superior-inferior direction and the anterior-posterior direction,separately or together,was simulated by considering different respiration amplitudes,periods and hysteresis.The influence of motion on CBCT image quality was evaluated with the quality indexes of low contrast visibility,geometric accuracy,spatial resolution and uniformity of CT values.The results showed that the quality indexes were affected by the motion more prominently in AP direction than in SI direction,and the image quality was affected by the respiration amplitude more prominently than the respiration period and the hysteresis.The CBCT image quality and its characteristics influenced by the respiration motion,and may be exploited in finding solutions.

Tissue Density Mapping of Cone Beam CT Images for Accurate Dose Calculations

Purpose: To improve the accuracy in megavoltage photon beam dose calculation in CBCT-based radiation treatment (RT) plans, using a kilovoltage cone-beam computed tomography (CBCT)-to-density-step (CBCT-SF) function. Materials and Methods: The CBCT-SF table is constructed from differential histograms of the voxel values of CBCT and Fan-beam CT (FBCT). From the CBCT histograms, frequency peaks representing air, lung, soft tissue and bone are observed and their widths in CT numbers are assigned to the lower and higher bounds of the steps in the CBCT-SF. The CBCT-SF is entered into a planning system as an alternative to the clinical CT-to-density table. The CT image sets studied in this work consist of FBCT and CBCT scans of three patients: a prostate cancer patient, a lung cancer patient and a head and neck patient;and of a humanoid phantom at sections of the pelvis, the thorax and the head. Deformable image registration is used to map the patient FBCT scans to the corresponding CBCT images to minimize anatomical variations. Three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) plans are made on the FBCT image sets of the patients and the phantom. The plans are recalculated on the CBCT scans using both the conventional CT-to-density table and the CBCT-SF. Dose calculations on the CBCT images and FBCT images are compared using dose differences, distance to agreement (DTA), Gamma analyses and dose volume histogram (DVH) analyses. Results: The results show that IMRT plans optimized using CBCT scans and FBCT scans agree dosimetrically within 1% when the CBCT-SF is used for the CBCT-based plans, including thoracic IMRT plan. In contrast, up to 5% dose difference is observed between IMRT plans optimized on FBCT scans and CBCT scans for thoracic cases if conventional CT-to-density table is used on CBCT images. Conclusions: The simple stepwise mapping of the CBCT numbers to density using the CBCT-SF resolves the inaccuracies in dose calculations previously reported in CBCT-based RT plans. CBCT-SF can be used in Image-Guided adaptive radiotherapy planning.

利用Cone-Beam CT探讨支抗微螺钉周围骨密度与其稳定性的关系

目的:利用Cone-Beam CT测量支抗微螺钉周围骨密度值,探讨其与微螺钉稳定性的关系。方法:选取颌骨左右对称植入微螺钉后一侧松动而另一侧稳固的7名(共18枚微螺钉)正畸患者。拍摄CBCT,所得三维影像重建后用OnDemand 3DApplication软件对微螺钉骨内部分周围2mm范围内骨密度(以Hounsfield Unit表示)进行测量,自身对照比较分析双侧对称部位所植入微螺钉周围骨密度测量值间的差异。结果:松动微螺钉与稳定微螺钉骨内部分周围2mm范围内骨密度无统计学差异,两侧微螺钉钉尖部1/3、钉中部1/3及钉颈部1/3周围骨密度均无统计学差异。结论:微螺钉种植支抗的稳定性与其周围骨密度间未发现明显相关性。

不同垂直骨面型下颌第一磨牙横向位置差异的CBCT研究

目的:使用锥形束CT(cone beam CT,CBCT)测量不同垂直骨面型下颌第一磨牙生理牙槽骨厚度,评估横向磨牙位置。方法:选取2023年1~10月在合肥市口腔医院正畸二科就诊患者50例,分为高角组、均角组及低角组,术前拍摄CBCT,数据导入配套三维软件进行4个部位不同深度牙槽骨厚度的测量分析。结果:高角患者下颌第一磨牙的骨厚度最小。下颌第一磨牙舌侧骨厚度高于颊侧。下颌第一磨牙釉牙骨质界根方4 mm处近中舌侧牙槽骨厚度高于远中舌侧,近中颊侧牙槽骨厚度与远中颊侧比较差异无统计学意义。下颌第一磨牙釉牙骨质界根方8 mm处远中颊侧牙槽骨厚度高于近中颊侧,近中舌侧的牙槽骨厚度与远中舌侧比较差异无统计学意义。下颌第一磨牙同一测量位点釉牙骨质界根方8 mm的牙槽骨厚度高于根方4 mm的牙槽骨厚度。结论:不同的垂直骨面型、测量部位、测量深度、牙齿解剖形态都会反映出下颌第一磨牙在牙槽骨中横向位置的差异。

基于Halcyon加速器百分百图像引导模式下盆腔肿瘤CTV-PTV边界外放的研究

目的探讨基于Halcyon加速器百分百图像引导模式下盆腔肿瘤临床靶区-计划靶区(Clinical Target Volume,CTV)-(Planning Target Volume,PTV)边界外放的摆位误差。方法选取2023年1—5月在Halcyon加速器上行调强放射治疗的19例盆腔肿瘤患者为研究对象,采集每个患者分次间、纠正后、分次内300套共900个锥形束CT图像,与计划CT进行配准融合,得到三维方向上的矢量误差,用X(左右)方向、Y(头脚)方向、Z(腹背)方向表示。计算摆位误差及分布趋势,并根据纠正后及分次内的摆位误差计算CTV-PTV的外放边界。结果X方向上,分次间、纠正后、分次内的摆位绝对误差分别为(2.07±1.82)、(0.19±0.19)、(0.30±0.28)mm;Y方向上,分次间、纠正后、分次内的摆位绝对误差分别为(3.87±2.67)、(0.23±0.31)、(0.27±0.23)mm;Z方向上,分次间、纠正后、分次内的摆位绝对误差分别为(0.72±0.83)、(0.20±0.22)、(0.30±0.27)mm,差异均有统计学意义(P<0.05)。纠正后和分次内X、Y、Z 3个方向分别有97%和96.33%的摆位误差在1 mm以内。CTV-PTV外放边界从6.36 mm缩小到1.06 mm。结论从摆位误差角度来看,基于Halcyon加速器百分百图像引导模式下的盆腔肿瘤治疗,根据纠正后和分次内的摆位误差计算CTV-PTV外放边界为1.1 mm。通过Halcyon加速器治疗盆腔肿瘤患者可降低摆位误差,提高患者靶区和危及器官的安全精度,缩小CTV-PTV边界外放值,减少正常组织的累及体积。

D-CBCT在肺癌容积旋转调强计划精准治疗中的临床应用

目的探讨椎形束CT(D-CBCT)在肺癌容积旋转调强(VMAT)计划精准治疗中的临床应用。方法选取2019年10月~2022年10月在南通市第三人民医院放射治疗科就诊的100例肺癌患者。根据CBCT扫描模式不同,分为4D组(n=57)和3D组(n=43)。比较两组患者放疗摆位误差、内靶区(ITV)体积、靶区剂量、心脏受照剂量和肿瘤控制效果。结果在校正前后和治疗后,两组各摆位误差绝对值无统计学差异(P>0.05);4D组患者中下叶肿瘤ITV体积低于3D组(P<0.05);4D组的最大剂量(D_(max))、最小剂量(D_(min))和平均剂量(D_(mean))靶区剂量均高于3D组(P<0.05);4D组的V10、V20、V30及平均受量(D_(mean))等心脏受照剂量均低于3D组(P<0.05);4D组和3D组患者的客观有效率无明显差异(P>0.05)。结论可将D-CBCT应用于肺癌容积旋转调强计划精准治疗中,尤其采用4D-CBCT可更好提供靶区剂量,减少肺癌患者的中下叶肿瘤ITV体积和心脏受照剂量。

情景式健康教育对肝癌介入术中CBCT伪影发生率的影响

目的分析情景式健康教育对肝癌术中锥形束CT(CBCT)伪影发生率的影响。方法纳入2023年1—12月在我院就诊的94例肝癌患者,术中均行CBCT检查,以患者入院时间先后顺序分为对照组(2023年1—6月)、观察组(2023年7—12月),两组各47例,对照组行常规健康教育,观察组在对照组基础上行情景式健康教育,对比两组的CBCT伪影发生率、负性情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)]及并发症发生率。结果与对照组相比,观察组CBCT伪影发生率更低(P<0.05)。干预前,两组SAS、SDS评分相比,差异无统计学意义(P>0.05);干预后,两组SAS、SDS评分均降低,且观察组更低(P<0.05)。与对照组相比,观察组并发症发生率更低(P<0.05)。结论对肝癌术中CBCT检查患者行情景式健康教育,可改善负性情绪,降低CBCT发生率及并发症发生率。

Detail-preserving ring artifact correction method for cone-beam CT

Ring artifact is the major factor that seriously influence quality of computed tomography(CT)image reconstruction,especially in testing large-scale workpieces.To remove ring artifact quickly and efficiently,a kind of ring artifact correction method is improved based on the post-processing CT image reconstruction in this paper.At first,transform the CT image from the rectangular coordinates into polar coordinates.Next,design multidimensional filter to filter the image and calculate the mean and variance of each filtered pixel in polar coordinates.The location of artifact point is determined by the double precision.One is the comparison of calculated variance and variance threshold,and another is the comparison of pixel value and pixel value threshold.Then,process the artifact points in a reasonable manner and do details remain to CT image in particular.At last,convert corrected polar image into rectangular coordinates.The actual experiment shows that compared with the original method,improved method can better correct the ring artifacts and keep the image details for CT images.It is a kind of practical ring artifact correction methods for subsequent processing and quantitative analysis.

探讨定量CT及生物电阻抗测定内脏脂肪面积和骨密度的关系

目的:探讨采用定量CT(Quantitative computer tomography,QCT)及生物电阻抗(Bioelectrical impedance analysis,BIA)测定内脏脂肪面积(Visceral fat area,VFA)与骨密度(Bone density,BMD)的关系。方法:回顾性选取郑州大学第一附属医院健康管理中心1131例体检者行QCT和BIA测定的VFA及BMD,采用Pearson相关系数、多因素线性回归、单因素和多因素Logistic回归分析二者的相关性;并采用Bland-Altman评估两者测定VFA的一致性。结果:Pearson相关分析显示QCT和BIA测定的VFA与BMD呈负相关(r=-0.197和r=-0.288)。多因素Logistic回归分析显示VFA(BIA)是骨量下降的危险因素(OR=1.010,95%CI:1.005~1.015);VFA(QCT)是骨量下降的危险因素(OR=1.003,95%CI:1.001~1.005);Bland-Altman分析显示,QCT和BIA测量VFA具有较高的一致性。结论:VFA是骨量下降的危险因素,测定VFA的QCT和BIA两者具有较高的一致性,可以采用BIA测定的VFA评估骨量下降。

Delivered Dose Verification for Lung Cancer Stereotactic Body Radiotherapy Using Cone-Beam CT

Purpose: Verified the delivered dose distribution of lung cancer Stereotactic Body Radiotherapy (SBRT) using the cone-beam CT images. Methods: Twenty lung cancer patients who underwent SBRT with 100 CBCT images were enrolled in this study. Delivered dose distributions were recalculated on CBCT images with the deformed and non-deformed methods, respectively. The planned and delivered dose distributions were compared using the dose-volume histograms. Results: The delivered target coverage (V100) per patient inside target volume deviated on average were 0.83% ± 0.86% and 1.38% ± 1.40% for Pct vs. Pcbct and Pct vs. Pdcbct, respectively. The Conformity Index (CI) and Gradient Index (GI) showed a good agreement among the plans. For the critical organs, only minor differences were observed between the planned dose and the delivered dose. Conclusions: CBCT images were a useful tool for setup and dose delivery verification for lung cancer patients who underwent SBRT.

CBCT引导下对三维治疗床与六维治疗床配准放疗摆位误差的研究

目的利用锥形束CT图像引导三维放射治疗床与六维放射治疗床配准精度,并分析其放疗摆位误差,为临床使用三维放射治疗床的放疗流程管理提供参考。方法选取50例鼻咽癌患者、49例食管癌患者和25例直肠癌患者治疗前的锥形束CT图像为研究对象,在离线配准下设置相同的感兴趣区域,分别选择三维放射治疗床的线性方向和六维放射治疗床的线性与旋转方向进行骨性配准,分析配准后产生的摆位误差。结果鼻咽癌与直肠癌患者分别采用秩和检验与方差齐性独立样本检验,升降(Vertical,Vrt)方向与左右(Lateral,Lat)方向差异均有统计学意义(P<0.05),进出(Longitudinal,Lng)方向差异无统计学意义(P>0.05);食管癌患者采用秩和检验,Vrt方向上差异有统计学意义(P<0.05),在Lng和Lat方向上差异均无统计学意义(P>0.05)。3个部位的Lng方向上差异均无统计学意义(P>0.05)。鼻咽癌、直肠癌、食管癌3种病例患者在线性方向的容差值分别为3、5、5 mm时,其中2、4、4 mm容差范围的数量占比较大;在平移方向,2种配准方式的摆位误差基本都在临床设定值的范围内。六维配准显示,鼻咽癌患者的头脚旋转方向与食管癌和直肠癌患者3个旋转方向的摆位误差较大。结论三维放射治疗床配准时反馈的摆位误差信息量低于六维放射治疗床,使用三维放射治疗床摆位时需加强放疗全流程与旋转方向摆位技术管理,提高放疗摆位效率与放疗增益比。

倒置埋伏阻生中切牙正畸牵引前后牙根发育的CBCT三维重建分析

目的:使用CBCT三维重建分析,探讨倒置埋伏阻生中切牙正畸牵引前后牙根发育的变化。方法:选择改良活动牵引器联合外科助萌治疗的10例上颌单侧倒置埋伏阻生中切牙患者,使用Mimics 21.0软件对治疗前后埋伏阻生中切牙(埋伏牙组)及对侧同名牙(健侧组)的CBCT数据进行三维重建,并计算牙体积与表面积。采用SPSS 26.0软件包进行配对t检验,比较治疗前后牙根发育情况。结果:10例患者均牵引成功,平均用时(16.10±4.46)个月。治疗后埋伏牙组牙体积与表面积均较治疗前显著增加(P<0.01)。牵引前和牵引后埋伏牙组牙体积与表面积均显著小于健侧组(P<0.01),但治疗过程中,埋伏牙组与健侧组牙体积与表面积的增加量无统计学差异(P>0.05)。结论:改良活动牵引器联合外科助萌可促进上颌倒置埋伏阻生中切牙牙根进一步发育,是一种安全可靠的治疗方法。

C臂锥形束CT引导下精准栓塞异位前列腺动脉治疗良性前列腺增生一例

良性前列腺增生的介入栓塞治疗是目前一种微创、有效的治疗方式,而精准辨识前列腺动脉(PA)是手术的关键。前列腺动脉异位起源于髂外动脉鲜有报道,笔者报道1例运用C臂锥形束CT精准辨识出异位前列腺动脉并在其引导下成功进行栓塞,术后盆腔MRI提示前列腺组织坏死明显,体积明显缩小,患者排尿困难症状明显改善。

用卷积神经网络U-Net分割对比增强锥光束乳腺CT数据

乳腺肿瘤是一种常见的恶性肿瘤,其临床诊断不但费时费力,还容易出现误诊.本文旨在建立一个基于乳腺数据自动分割的乳腺肿瘤计算机辅助诊断模型,提高临床诊断的速度和准确率.为了用卷积神经网络U-Net模型分割对比增强锥光束乳腺计算机断层扫描(Contrast-Enhanced Cone-Beam Breast CT,CE-CBBCT)数据,本文首先沿冠状面将3维数据转换成2维切片,通过数据默认的窗口对其进行归一化处理.实验结果显示,使用U-Net卷积神经网络对数据进行分割,Dice系数和IoU(Intersection over Union)分别为0.7920和0.6962.然后,本文用不同骨干网络(即各种深度学习分类网络)去替换U-Net的编码器,再次进行分割并对比不同特征提取对分割性能的影响,发现旋转增广方式可以提升各分割网络的性能.其中,基于ResNet152的U形分割网络的性能最好,Dice系数和IoU分别达到0.8410和0.7576.随后,本文又在所有模型中选取5个性能最好的模型组成一个集成模型,重复分割实验,发现此模型有最佳分割性能,平均Dice系数和IoU可达0.8463和0.7676,性能显著提升.值得指出的是,在处理数据时本文仅使用数据默认的窗口,降低了对人工的依赖.

基于双调和插值的锥束CT金属伪影校正算法

在计算机断层扫描(CT)中,金属植入物会引入严重的伪影,导致图像质量降低影响诊断价值。为了对锥束CT中的金属伪影进行校正,提出了一种基于双调和方程的金属伪影校正算法。首先,对含金属伪影的重建图像进行双边滤波和金属阈值分割,获得金属和非金属图像;然后,对二者进行正向投影,获得金属投影区域和先验投影图像;接下来,利用先验投影图像对原始投影进行归一化,并对金属区域进行双调和方程插值修复,获得修复的投影数据;最后,对修复的投影数据去归一化,并利用FDK算法进行重建,再与金属图像融合获得最终的校正图像。为了验证该算法的性能,采用实际拍摄的数据进行金属伪影校正实验。结果表明,与常用的线性插值校正算法和归一化校正算法相比,所提算法ROI区域内图像的均方根误差分别减少了22%和8%,有效地抑制了金属伪影,优于常用的去金属伪影算法。

基于锥形束CT研究不同部位计划靶区外放边界

目的:基于千伏级锥形束CT(cone beam CT,CBCT)图像引导技术,对放射治疗摆位误差进行修正,统计分析不同方向摆位误差值,并以此确定人体不同部位计划靶区外放边界。方法:选取头部、颈胸部、胸部和腹部肿瘤患者各30例,共120例。每例患者治疗期间选择第1、6、11、16、21、...次治疗,即每五次做一次治疗前的CBCT扫描、配准,获取摆位误差,计算PTV外放边界。结果:不同部位X轴、Y轴、Z轴三个方向的摆位误差(均值±标准差)为:头部X轴(1.06±0.08)、Y轴(1.45±1.06)、Z轴(0.87±0.62),颈胸部X轴(1.71±1.24)、Y轴(2.14±1.22)、Z轴(1.65±1.17),胸部X轴(1.62±1.19)、Y轴(1.56±1.15)、Z轴(1.43±1.00),腹部X轴(1.30±1.07)、Y轴(1.61±1.21)、Z轴(1.42±1.01)。肿瘤临床靶区(CTV)至计划靶区(PTV)的外放边界(Margin)在X轴、Y轴、Z轴方向上分别为:头部2.53 mm、2.96 mm、1.66 mm,颈胸部2.84 mm、2.71 mm、2.67 mm,胸部2.47 mm、2.38 mm、2.39 mm,腹部2.38 mm、2.40 mm、2.11 mm。结论:基于CBCT摆位误差得到的计划靶区外放边界在临床放射治疗中具有指导意义。

The Association between Lower Incisal Inclination and Morphology of the Supporting Alveolar Bone—A Cone-Beam CT Study

Aim To investigate the relationship between the positioning of the lower central incisor and physical morphology of the surrounding alveolar bone. Methodology Thirty-eight patients （18 males, 20 females）, with mean age of 13.4 years, were included in this study. As part of orthodontic treatment planning the patients were required to take dental Cone-beam CT （CBCT） covering the region of lower incisors, the sur- rounding alveolar bone and the mandibular symphysis. The cephalometric parameters were designed and measured to indicate the inclination of lower central incisor and physical morphology of the adjacent alveolar bone. Computer-aided descriptive statistical analysis was performed using SPSS 15.0 software package for Windows. A correlation analysis and a linear regression analysis between the incisor inclination and the alveolar bone morphology were performed. Results Significant positive correlations were found between the lower central incisor inclination and the morphological contour of the alveolar bone （P〈0.05）. The lower central incisor root apex was closer to the lingual alveolar crest when it was buccally inclined. Conclusion The morphology of the alveolar bone may be affected by incisal inclination.