• Korean Journal of Radiology
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• v.24 no.10
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• pp.1006-1016
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• 2023

Objective: Computed tomography (CT) is an established method for the diagnosis, staging, and treatment of multiple myeloma. Here, we investigated the potential of photon-counting detector computed tomography (PCD-CT) in terms of image quality, diagnostic confidence, and radiation dose compared with energy-integrating detector CT (EID-CT). Materials and Methods: In this prospective study, patients with known multiple myeloma underwent clinically indicated whole-body PCD-CT. The image quality of PCD-CT was assessed qualitatively by three independent radiologists for overall image quality, edge sharpness, image noise, lesion conspicuity, and diagnostic confidence using a 5-point Likert scale (5 = excellent), and quantitatively for signal homogeneity using the coefficient of variation (CV) of Hounsfield Units (HU) values and modulation transfer function (MTF) via the full width at half maximum (FWHM) in the frequency space. The results were compared with those of the current clinical standard EID-CT protocols as controls. Additionally, the radiation dose (CTDIvol) was determined. Results: We enrolled 35 patients with multiple myeloma (mean age 69.8 ± 9.1 years; 18 [51%] males). Qualitative image analysis revealed superior scores (median [interquartile range]) for PCD-CT regarding overall image quality (4.0 [4.0-5.0] vs. 4.0 [3.0-4.0]), edge sharpness (4.0 [4.0-5.0] vs. 4.0 [3.0-4.0]), image noise (4.0 [4.0-4.0] vs. 3.0 [3.0-4.0]), lesion conspicuity (4.0 [4.0-5.0] vs. 4.0 [3.0-4.0]), and diagnostic confidence (4.0 [4.0-5.0] vs. 4.0 [3.0-4.0]) compared with EID-CT (P ≤ 0.004). In quantitative image analyses, PCD-CT compared with EID-CT revealed a substantially lower FWHM (2.89 vs. 25.68 cy/pixel) and a significantly more homogeneous signal (mean CV ± standard deviation [SD], 0.99 ± 0.65 vs. 1.66 ± 0.5; P < 0.001) at a significantly lower radiation dose (mean CTDIvol ± SD, 3.33 ± 0.82 vs. 7.19 ± 3.57 mGy; P < 0.001). Conclusion: Whole-body PCD-CT provides significantly higher subjective and objective image quality at significantly reduced radiation doses than the current clinical standard EID-CT protocols, along with readily available multi-spectral data, facilitating the potential for further advanced post-processing.

• Korean Journal of Radiology
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• v.23 no.11
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• pp.1044-1054
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• 2022

Objective: This study aimed to investigate whether a deep learning reconstruction (DLR) method improves the image quality, stent evaluation, and visibility of the valve apparatus in coronary computed tomography angiography (CCTA) when compared with filtered back projection (FBP) and hybrid iterative reconstruction (IR) methods. Materials and Methods: CCTA images of 51 patients (mean age ± standard deviation [SD], 63.9 ± 9.8 years, 36 male) who underwent examination at a single institution were reconstructed using DLR, FBP, and hybrid IR methods and reviewed. CT attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and stent evaluation, including 10%-90% edge rise slope (ERS) and 10%-90% edge rise distance (ERD), were measured. Quantitative data are summarized as the mean ± SD. The subjective visual scores (1 for worst -5 for best) of the images were obtained for the following: overall image quality, image noise, and appearance of stent, vessel, and aortic and tricuspid valve apparatus (annulus, leaflets, papillary muscles, and chordae tendineae). These parameters were compared between the DLR, FBP, and hybrid IR methods. Results: DLR provided higher Hounsfield unit (HU) values in the aorta and similar attenuation in the fat and muscle compared with FBP and hybrid IR. The image noise in HU was significantly lower in DLR (12.6 ± 2.2) than in hybrid IR (24.2 ± 3.0) and FBP (54.2 ± 9.5) (p < 0.001). The SNR and CNR were significantly higher in the DLR group than in the FBP and hybrid IR groups (p < 0.001). In the coronary stent, the mean value of ERS was significantly higher in DLR (1260.4 ± 242.5 HU/mm) than that of FBP (801.9 ± 170.7 HU/mm) and hybrid IR (641.9 ± 112.0 HU/mm). The mean value of ERD was measured as 0.8 ± 0.1 mm for DLR while it was 1.1 ± 0.2 mm for FBP and 1.1 ± 0.2 mm for hybrid IR. The subjective visual scores were higher in the DLR than in the images reconstructed with FBP and hybrid IR. Conclusion: DLR reconstruction provided better images than FBP and hybrid IR reconstruction.

• Korean Journal of Radiology
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• v.20 no.4
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• pp.671-682
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• 2019

Objective: To investigate whether computed tomography (CT) and fluorine-18-labeled fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) may be applied to distinguish thymic epithelial tumors (TETs) from benign cysts in the anterior mediastinum. Materials and Methods: We included 262 consecutive patients with pathologically proven TETs and benign cysts 5 cm or smaller who underwent preoperative CT scans. In addition to conventional morphological and ancillary CT findings, the relationship between the lesion and the adjacent mediastinal pleura was evaluated qualitatively and quantitatively. Mean lesion attenuation was measured on CT images. The maximum standardized uptake value (SUVmax) was obtained with FDG-PET scans in 40 patients. CT predictors for TETs were identified with multivariate logistic regression analysis. For validation, we assessed the diagnostic accuracy and inter-observer agreement between four radiologists in a size-matched set of 24 cysts and 24 TETs using a receiver operating characteristic curve before and after being informed of the study findings. Results: The multivariate analysis showed that post-contrast attenuation of 60 Hounsfield unit or higher (odds ratio [OR], 12.734; 95% confidence interval [CI], 2.506-64.705; p = 0.002) and the presence of protrusion from the mediastinal pleura (OR, 9.855; 95% CI, 1.749-55.535; p = 0.009) were the strongest CT predictors for TETs. SUVmax was significantly higher in TETs than in cysts (5.3 ± 2.4 vs. 1.1 ± 0.3; p < 0.001). After being informed of the study findings, the readers' area under the curve improved from 0.872-0.955 to 0.949-0.999 (p = 0.066-0.149). Inter-observer kappa values for protrusion were 0.630-0.941. Conclusion: Post-contrast CT attenuation, protrusion from the mediastinal pleura, and SUVmax were useful imaging features for distinguishing TETs from cysts in the anterior mediastinum.

• Korean Journal of Radiology
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• v.21 no.12
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• pp.1285-1293
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• 2020

Objective: To evaluate the effects of vasodilators on contrast enhancement and transluminal attenuation gradient (TAG) of coronary arteries at coronary computed tomography angiography (CCTA). Materials and Methods: We retrospectively reviewed CCTA scans of patients who underwent double-acquisition CCTA; CCTA without a vasodilator, and CCTA during a intravenous (IV) infusion of nitrate. Among them, we enrolled 19 patients who had no significant atherosclerotic lesions or coronary spasms. In the control group, 28 patients were enrolled who showed normal coronary arteries on CCTA, which was acquired by a conventional method (sublingual vasodilator). We measured the TAG and Hounsfield units for each of the three major epicardial coronary arteries (reported as 'ProxHU') and then compared the results between the nitrate administration methods (CT without vasodilator [CT_pre], CT with IV vasodilator [CT_iv], and CT with sublingual vasodilator [CT_sub]). Results: The mean TAG showed a significant difference between the coronary arteries (right coronary artery [RCA] > left anterior descending artery [LAD] > left circumflex artery [LCX], p < 0.05), while there was no difference in ProxHU of each coronary artery in all three types of nitrate administration methods (p > 0.05). The TAG of CT_pre group showed steeper slope than those of vasodilator groups (CT_iv and CT_sub) on LAD and LCX ([LAD: CT_pre = -22.1 ± 6.66, CT_iv = -16.76 ± 5.78, and CT_sub = -16.47 ± 5.78, p = 0.005], [LCX: CT_pre = -31.26 ± 17.43, CT_iv = -23.74 ± 14.06, and CT_sub = -20.94 ± 12.15, p = 0.051]), while that of RCA showed no significant differences (p = 0.600). When comparing proxHU, CT_iv showed higher proxHU than that of CT_pre or CT_sub, especially on LCX (CT_pre = 426.7 ± 68.3, CT_iv = 467.9 ± 84.9, and CT_sub = 404.9 ± 63.3, p = 0.013). ProxHU showed a negative correlation with TAG on all three of methods (r = -0.280, p < 0.001). Conclusion: TAG in CCTA was significantly affected by vasodilator administration. Both TAG and ProxHU of coronary arteries tend to increase with vasodilator administration on CCTA.

• The Journal of Korean Society for Radiation Therapy
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• v.29 no.2
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• pp.9-17
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• 2017

Purpose: The tissue description and electron density indicated by the Computed Tomography(CT) number (also known as Hounsfield Unit) in radiotherapy are important in ensuring the accuracy of CT-based computerized radiotherapy planning. The internal metal implants, however, not only reduce the accuracy of CT number but also introduce uncertainty into tissue description, leading to development of many clinical algorithms for reducing metal artifacts. The purpose of this study was, therefore, to investigate the accuracy and the clinical applicability by analyzing date from SMART MAR (GE) used in our institution. Methode: and material: For assessment of images, the original images were obtained after forming ROIs with identical volumes by using CIRS ED phantom and inserting rods of six tissues and then non-SMART MAR and SMART MAR images were obtained and compared in terms of CT number and SD value. For determination of the difference in dose by the changes in CT number due to metal artifacts, the original images were obtained by forming PTV at two sites of CIRS ED phantom CT images with Computerized Treatment Planning (CTP system), the identical treatment plans were established for non-SMART MAR and SMART MAR images by obtaining unilateral and bilateral titanium insertion images, and mean doses, Homogeneity Index(HI), and Conformity Index(CI) for both PTVs were compared. The absorbed doses at both sites were measured by calculating the dose conversion constant (cCy/nC) from ylinder acrylic phantom, 0.125cc ionchamber, and electrometer and obtaining non-SMART MAR and SMART MAR images from images resulting from insertions of unilateral and bilateral titanium rods, and compared with point doses from CTP. Result: The results of image assessment showed that the CT number of SMART MAR images compared to those of non-SMART MAR images were more close to those of original images, and the SD decreased more in SMART compared to non-SMART ones. The results of dose determinations showed that the mean doses, HI and CI of non-SMART MAR images compared to those of SMART MAR images were more close to those of original images, however the differences did not reach statistical significance. The results of absorbed dose measurement showed that the difference between actual absorbed dose and point dose on CTP in absorbed dose were 2.69 and 3.63 % in non-SMRT MAR images, however decreased to 0.56 and 0.68 %, respectively in SMART MAR images. Conclusion: The application of SMART MAR in CT images from patients with metal implants improved quality of images, being demonstrated by improvement in accuracy of CT number and decrease in SD, therefore it is considered that this method is useful in dose calculation and forming contour between tumor and normal tissues.

• The Journal of the Korea Contents Association
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• v.9 no.12
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• pp.742-749
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• 2009

The use of cone-beam computed tomography(CBCT) has been proposed for guiding the delivery of radiation therapy. A kilovoltage imaging system capable of radiography, fluoroscopy, and cone-beam computed tomography(CT) has been integrated with a medical linear accelerator. A standard clinical linear accelerator, operating in arc therapy mode, and an amorphous-silicon (a-Si) with an on-board electronic portal imager can be used to treat palliative patient and verify the patient's position prior to treatment. On-board CBCT images are used to generate patient geometric models to assist patient setup. The image data can also, potentially, be used for dose reconstruction in combination with the fluence maps from treatment plan. In this study, the accuracy of Hounsfield Units of CBCT images as well as the accuracy of dose calculations based on CBCT images of a phantom and compared the results with those of using CT simulator images. Phantom and patient studies were carried out to evaluate the achievable accuracy in using CBCT and CT stimulator for dose calculation. Relative electron density as a function of HU was obtained for both planning CT stimulator and CBCT using a Catphan-600 (The Phantom Laboratory, USA) calibration phantom. A clinical treatment planning system was employed for CT stimulator and CBCT based dose calculations and subsequent comparisons. The dosimetric consequence as the result of HU variation in CBCT was evaluated by comparing MU/cCy. The differences were about 2.7% (3-4MU/100cGy) in phantom and 2.5% (1-3MU/100cGy) in patients. The difference in HU values in Catphan was small. However, the magnitude of scatter and artifacts in CBCT images are affected by limitation of detector's FOV and patient's involuntary motions. CBCT images included scatters and artifacts due to In addition to guide the patient setup process, CBCT data acquired prior to the treatment be used to recalculate or verify the treatment plan based on the patient anatomy of the treatment area. And the CBCT has potential to become a very useful tool for on-line ART.)

• Journal of radiological science and technology
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• v.31 no.1
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• pp.71-81
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• 2008

Our objective was to evaluate the image of spatial domain filtering as an alternative to additional image reconstruction using different kernels in MDCT. Derived from thin collimated source images were generated using water phantom and abdomen B10(very smooth), B20(smooth), B30(medium smooth), B40 (medium), B50(medium sharp), B60(sharp), B70(very sharp) and B80(ultra sharp) kernels. MTF and spatial resolution measured with various convolution kernels. Quantitative CT attenuation coefficient and noise measurements provided comparable HU(Hounsfield) units in this respect. CT attenuation coefficient(mean HU) values in the water were values in the water were $1.1{\sim}1.8\;HU$, air($-998{\sim}-1000\;HU$) and noise in the water($5.4{\sim}44.8\;HU$), air($3.6{\sim}31.4\;HU$). In the abdominal fat a CT attenuation coefficient($-2.2{\sim}0.8\;HU$) and noise($10.1{\sim}82.4\;HU$) was measured. In the abdominal was CT attenuation coefficient($53.3{\sim}54.3\;HU$) and noise($10.4{\sim}70.7\;HU$) in the muscle and in the liver parenchyma of CT attenuation coefficient($60.4{\sim}62.2\;HU$) and noise ($7.6{\sim}63.8\;HU$) in the liver parenchyma. Image reconstructed with a convolution kernel led to an increase in noise, whereas the results for CT attenuation coefficient were comparable. Image scanned with a high convolution kernel(B80) led to an increase in noise, whereas the results for CT attenuation coefficient were comparable. Image medications of image sharpness and noise eliminate the need for reconstruction using different kernels in the future. Adjusting CT various kernels, which should be adjusted to take into account the kernels of the CT undergoing the examination, may control CT images increase the diagnostic accuracy.

• Proceedings of the Korea Contents Association Conference
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• 2009.05a
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• pp.1159-1166
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• 2009

The use of cone-beam computed tomography(CBCT) has been proposed for guiding the delivery of radiation therapy. A kilovoltage imaging system capable of radiography, fluoroscopy, and cone-beam computed tomography(CT) has been integrated with a medical linear accelerator. A standard clinical linear accelerator, operating in arc therapy mode, and an amorphous-silicon (a-Si) with an on-board electronic portal imager can be used to treat palliative patient and verify the patient's position prior to treatment. On-board CBCT images are used to generate patient geometric models to assist patient setup. The image data can also, potentially, be used for dose reconstruction in combination with the fluence maps from treatment plan. In this study, the accuracy of Hounsfield Units of CBCT images as well as the accuracy of dose calculations based on CBCT images of a phantom and compared the results with those of using CT simulator images. Phantom and patient studies were carried out to evaluate the achievable accuracy in using CBCT and CT stimulator for dose calculation. Relative electron density as a function of HU was obtained for both planning CT stimulator and CBCT using a Catphan-600 (The Phantom Laboratory, USA) calibration phantom. A clinical treatment planning system was employed for CT stimulator and CBCT based dose calculations and subsequent comparisons. The dosimetric consequence as the result of HU variation in CBCT was evaluated by comparing MU/cCy. The differences were about 2.7% (3-4MU/100cGy) in phantom and 2.5% (1-3MU/100cGy) in patients. The difference in HU values in Catphan was small. However, the magnitude of scatter and artifacts in CBCT images are affected by limitation of detector's FOV and patient's involuntary motions. CBCT images included scatters and artifacts due to In addition to guide the patient setup process, CBCT data acquired prior to the treatment be used to recalculate or verify the treatment plan based on the patient anatomy of the treatment area. And the CBCT has potential to become a very useful tool for on-line ART.)

• Progress in Medical Physics
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• v.23 no.1
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• pp.62-69
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• 2012

The dose re-calculation process using Megavoltage cone-beam CT images is inevitable process to perform the Adaptive Radiation Therapy (ART). The purpose of this study is to improve dose re-calculation accuracy using MVCBCT images by applying intensity calibration method and three dimensional rigid body transform and filtering process. The three dimensional rigid body transform and Gaussian smoothing filtering process to MVCBCT Rando phantom images was applied to reduce image orientation error and the noise of the MVCBCT images. Then, to obtain the predefined modification level for intensity calibration, the cheese phantom images from kilo-voltage CT (kV CT), MVCBCT was acquired. From these cheese phantom images, the calibration table for MVCBCT images was defined from the relationship between Hounsfield Units (HUs) of kV CT and MVCBCT images at the same electron density plugs. The intensity of MVCBCT images from Rando phantom was calibrated using the predefined modification level as discussed above to have the intensity of the kV CT images to make the two images have the same intensity range as if they were obtained from the same modality. Finally, the dose calculation using kV CT, MVCBCT with/without intensity calibration was applied using radiation treatment planning system. As a result, the percentage difference of dose distributions between dose calculation based on kVCT and MVCBCT with intensity calibration was reduced comparing to the percentage difference of dose distribution between dose calculation based on kVCT and MVCBCT without intensity calibration. For head and neck, lung images, the percentage difference between kV CT and non-calibrated MVCBCT images was 1.08%, 2.44%, respectively. In summary, our method has quantitatively improved the accuracy of dose calculation and could be a useful solution to enhance the dose calculation accuracy using MVCBCT images.

• Journal of the Korean Society of Radiology
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• v.6 no.2
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• pp.93-98
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• 2012

Micro-computed tomography (microCT) is an important tool for preclinical vascular imaging, with micron-level resolution. This non-destructive means of imaging allows for rapid collection of 2D and 3D reconstructions to visualize specimens prior to destructive analysis such as pathological analysis. Objectives. The aim of this study was to suggest a method for ex vivo, postmortem examination of stented arterial segments with microCT. And ex vivo evaluation of stents such as bare metal or drug eluting stents on in-stent restenosis (ISR) in rabbit model was performed. The bare metal stent (BMS) and drug eluting stent (DES, paclitaxel) were implanted in the left or right iliac arteries alternatively in eight New Zealand white rabbits. After 4 weeks of post-implantation, the part of iliac arteries surrounding the stent were removed carefully and processed for microCT. Prior to microCT analysis, a contrast medium was loaded to lumen of stents. All samples were subjected to an X-ray source operating at 50 kV and 200 ${\mu}A$ by using a 3D isotropic resolution. The region of interest was traced and measured by CTAN analytical software. Objects being exposed to radiation had different Hounsfield unit each other with values of approximately 1.2 at stent area, 0.12 ~ 0.17 at a contrast medium and 0 ~ 0.06 at outer area of stent. Based on above, further analyses were performed. As a result, the difference of lengths and volumes between expanded stents, which may relate to injury score in pathological analysis, was not different significantly. Moreover, ISR area of BMS was 1.6 times higher than that of DES, indicating that paclitaxel has inhibitory effect on cell proliferation and prevent infiltration of restenosis into lumen of stent. And ISR area of BMS was higher ($1.52{\pm}0.48mm^2$) than that of DES ($0.94{\pm}0.42mm^2$), indicating that paclitaxel has inhibitory effect on cell proliferation and prevent infiltration of restenosis into lumen of stent. Though it was not statistically significant, it showed that the extent of neointema of mid-region of stents was relatively higher than that of anterior and posterior region in parts of BMS as showing cross-sectional 2-D image. suggest that microCT can be utilized as an accessorial tool for pathological analysis.