Search results for: cone-beam computed tomography CBCT

Authors: Areej R. Banjar, Abraham G. Campbell

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The use of Mixed Reality (MR) in teaching and training is growing popular and can improve students’ ability to perform technical procedures. This short paper outlines the creation of an interactive educational MR 3D application that aims to improve the quality of instruction for dentistry students. This application is called MRImplantology and aims to teach the fundamentals and preoperative planning of dental implant placement. MRImplantology uses cone-beam computed tomography (CBCT) images as the source for 3D dental models that dentistry students will be able to freely manipulate within a 3D MR world to aid their learning process.

Keywords: augmented reality, education, dentistry, cone-beam computed tomography CBCT, head mounted display HMD, mixed reality

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Authors: H. El-Messiry, M. El-Zainy, D. Abdelkhalek

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Cone-beam computed tomography (CBCT) provides high-quality 3-dimensional images of dental structures because of its high spatial resolution. The study of dental morphology is important in research as it provides information about diversities within a population. Many studies have shown different shapes and numbers of roots canals among different races, especially in molars. The aim of this study was to determine the morphology of root canals of mandibular first and third molars in a sample of Egyptian population using CBCT scanning. Fifty mandibular first Molars (M1) and fifty mandibular third (M3) extracted molars were collected. Thick rectangular molds were made using pink wax to hold the samples. Molars were embedded in the wax mold by aligning them in rows leaving arbitrary 0.5cm space between them. The molds with the samples in were submitted for CBCT scan. The number and morphology of root canals were assessed and classified according to Vertucci's classification. The mesial and the distal roots were examined separately. Finally, data was analyzed using Fisher exact test. The most prevalent mesial root canal frequency in M1 was type IV (60%) and type II (40 %), while M3 showed prevalence of type I (40%) and II (40%). Distal root canal morphology showed prevalence of type I in both M1 (66%) and M3 (86%). So, it can be concluded that CBCT scanning provides supplemental information about the root canal configurations of mandibular molars in a sample of Egyptian population. This study may help clinicians in the root canal treatment of mandibular molars.

Keywords: cone beam computed tomography, mandibular first molar, mandibular third molar, root canal morphology

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Authors: Keerthilatha Pai, Sakshi Kamra

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Objectives: Determining the position of the mandibular canal prior to implant placement and surgeries of the posterior mandible are important to avoid the nerve injury. The visibility of the mandibular canal varies according to the imaging modality. Although panoramic radiography is the most common, slowly cone beam computed tomography is replacing it. This study was conducted with an aim to determine and compare the visibility of superior and inferior borders of the mandibular canal in digital panoramic radiograph, reformatted panoramic radiograph and cross-sectional images of cone beam computed tomography. Study design: digital panoramic, reformatted panoramic radiograph and cross sectional CBCT images of 25 human mandibles were evaluated for the visibility of the superior and inferior borders of the mandibular canal according to a 5 point scoring criteria. Also, the canal was evaluated as completely visible, partially visible and not visible. The mean scores and visibility percentage of all the imaging modalities were determined and compared. The interobserver and intraobserver agreement in the visualization of the superior and inferior borders of the mandibular canal were determined. Results: The superior and inferior borders of the mandibular canal were completely visible in 47% of the samples in digital panoramic, 63% in reformatted panoramic and 75.6% in CBCT cross-sectional images. The mandibular canal was invisible in 24% of samples in digital panoramic, 19% in reformatted panoramic and 2% in cross-sectional CBCT images. Maximum visibility was seen in Zone 5 and least visibility in Zone 1. On comparison of all the imaging modalities, CBCT cross-sectional images showed better visibility of superior border in Zones 2,3,4,6 and inferior border in Zones 2,3,4,6. The difference was statistically significant. Conclusion: CBCT cross-sectional images were much superior in the visualization of the mandibular canal in comparison to reformatted and digital panoramic radiographs. The inferior border was better visualized in comparison to the superior border in digital panoramic imaging. The mandibular canal was maximumly visible in posterior one-third region of the mandible and the visibility decreased towards the mental foramen.

Keywords: cone beam computed tomography, mandibular canal, reformatted panoramic radiograph, visualization

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Authors: Anurag Tripathi, Sanad Khandelwal

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Age and gender determination are required in forensic for victim identification. There is secondary dentine deposition throughout life, resulting in decreased pulp volume and size. Evaluation of pulp volume using Cone Beam Computed Tomography (CBCT)is a noninvasive method to evaluate the age and gender of an individual. The study was done to evaluate the efficacy of pulp volume method in the determination of age and gender.Aims/Objectives: The study was conducted to estimate age and determine sex by measuring tooth pulp volume with the help of CBCT. An observational study of one year duration on CBCT data of individuals was conducted in Lucknow. Maxillary central incisors (CI) and maxillary canine (C) of the randomly selected samples were assessed for measurement of pulp volume using a software. Statistical analysis: Chi Square Test, Arithmetic Mean, Standard deviation, Pearson’s Correlation, Linear & Logistic regression analysis. Results: The CBCT data of Ninety individuals with age range between 18-70 years was evaluated for pulp volume of central incisor and canine (CI & C). The Pearson correlation coefficient between the tooth pulp volume (CI & C) and chronological age suggested that pulp volume decreased with age. The validation of the equations for sex determination showed higher prediction accuracy for CI (56.70%) and lower for C (53.30%).Conclusion: Pulp volume obtained from CBCT is a reliable indicator for age estimation and gender prediction.

Keywords: forensic, dental age, pulp volume, cone beam computed tomography

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Authors: Saba Fahham, Supak Ngamsom, Suchaya Damrongsri

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Objective: The objective is to determine the optimal threshold of Romexis software for the airway volume and minimum cross-section area (MCA) analysis using Image J as a gold standard. Materials and Methods: A total of ten cone-beam computed tomography (CBCT) images were collected. The airway volume and MCA of each patient were analyzed using the automatic airway segmentation function in the CBCT DICOM viewer (Romexis). Airway volume and MCA measurements were conducted on each CBCT sagittal view with fifteen different threshold values from the Romexis software, Ranging from 300 to 1000. Duplicate DICOM files, in axial view, were imported into Image J for concurrent airway volume and MCA analysis as the gold standard. The airway volume and MCA measured from Romexis and Image J were compared using a t-test with Bonferroni correction, and statistical significance was set at p<0.003. Results: Concerning airway volume, thresholds of 600 to 850 as well as 1000, exhibited results that were not significantly distinct from those obtained through Image J. Regarding MCA, employing thresholds from 400 to 850 within Romexis Viewer showed no variance from Image J. Notably, within the threshold range of 600 to 850, there were no statistically significant differences observed in both airway volume and MCA analyses, in comparison to Image J. Conclusion: This study demonstrated that the utilization of Planmeca Romexis Viewer 6.4.3.3 within threshold range of 600 to 850 yields airway volume and MCA measurements that exhibit no statistically significant variance in comparison to measurements obtained through Image J. This outcome holds implications for diagnosing upper airway obstructions and post-orthodontic surgical monitoring.

Keywords: airway analysis, airway segmentation, cone beam computed tomography, threshold

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Authors: N. L. S. Ahmad, Y. L. Thong, P. Nambiar

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An in vitro study was carried out to evaluate the feasibility of small field of view (FOV) cone beam computed tomography (CBCT) in determining endodontic working length. The objectives were to determine the accuracy of CBCT in measuring the estimated preoperative working lengths (EPWL), endodontic working lengths (EWL) and file lengths. Access cavities were prepared in 27 molars. For each root canal, the baseline electronic working length was determined using an EAL (Raypex 5). The teeth were then divided into overextended, non-modified and underextended groups and the lengths were adjusted accordingly. Imaging and measurements were made using the respective software of the RVG (Kodak RVG 6100) and CBCT units (Kodak 9000 3D). Root apices were then shaved and the apical constrictions viewed under magnification to measure the control working lengths. The paired t-test showed a statistically significant difference between CBCT EPWL and control length but the difference was too small to be clinically significant. From the Bland Altman analysis, the CBCT method had the widest range of 95% limits of agreement, reflecting its greater potential of error. In measuring file lengths, RVG had a bigger window of 95% limits of agreement compared to CBCT. Conclusions: (1) The clinically insignificant underestimation of the preoperative working length using small FOV CBCT showed that it is acceptable for use in the estimation of preoperative working length. (2) Small FOV CBCT may be used in working length determination but it is not as accurate as the currently practiced method of using the EAL. (3) It is also more accurate than RVG in measuring file lengths.

Keywords: accuracy, CBCT, endodontics, measurement

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Authors: Auwal Abubakar, Ahmed Ahidjo, Shazril Imran Shaukat, Noor Khairiah A. Karim, Gokula Kumar Appalanaido, Hafiz Mohd Zin

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Background: The use of optical surface imaging systems (OSISs) is increasingly becoming popular in radiotherapy practice, especially during breast cancer treatment. This study reviews the accuracy of the available commercial OSISs for breast radiotherapy. Method: A literature search was conducted and identified the available commercial OSISs from different manufacturers that are integrated into radiotherapy practice for setup verification during breast radiotherapy. Studies that evaluated the accuracy of the OSISs during breast radiotherapy using cone beam computed tomography (CBCT) as a reference were retrieved and analyzed. The physics and working principles of the systems from each manufacturer were discussed together with their respective strength and limitations. Results: A total of five (5) different commercially available OSISs from four (4) manufacturers were identified, each with a different working principle. Six (6) studies were found to evaluate the accuracy of the systems during breast radiotherapy in conjunction with CBCT as a goal standard. The studies revealed that the accuracy of the system in terms of mean difference ranges from 0.1 to 2.1 mm. The correlation between CBCT and OSIS ranges between 0.4 and 0.9. The limit of agreements obtained using bland Altman analysis in the studies was also within an acceptable range. Conclusion: The OSISs have an acceptable level of accuracy and could be used safely during breast radiotherapy. The systems are non-invasive, ionizing radiation-free, and provide real-time imaging of the target surface at no extra concomitant imaging dose. However, the system should only be used to complement rather than replace x-ray-based image guidance techniques such as CBCT.

Keywords: optical surface imaging system, Cone beam computed tomography (CBCT), surface guided radiotherapy, Breast radiotherapy

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Authors: Zeena Dcosta, Junaid Ahmed, Ceena Denny, Nandita Shenoy

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In the field of dentistry, there are many conditions which warrant the requirement of three-dimensional imaging that can aid in diagnosis and therapeutic management. Cone beam computed tomography (CBCT) is considered highly accurate in producing a three-dimensional image of an object and provides a complete insight of various findings in the captured volume. But, most of the clinicians focus primarily on the teeth and jaws and numerous unanticipated clinically significant incidental findings may be missed out. Rapid integration of CBCT into the practice of dentistry has led to the detection of various incidental findings. However, the prevalence of these incidental findings is still unknown. Thus, the study aimed to discern the reason for referral and to identify incidental findings on the referred CBCT scans. Patient’s demographic data such as age and gender was noted. CBCT scans of multiple fields of views (FOV) were considered. The referral for CBCT scans was broadly classified into two major categories: diagnostic scan and treatment planning scan. Any finding on the CBCT volumes, other than the area of concern was recorded as incidental finding which was noted under airway, developmental, pathological, endodontics, TMJ, bone, soft tissue calcifications and others. Few of the incidental findings noted under airway were deviated nasal septum, nasal turbinate hypertrophy, mucosal thickening and pneumatization of sinus. Developmental incidental findings included dilaceration, impaction, pulp stone and gubernacular canal. Resorption of teeth and periapical pathologies were noted under pathological incidental findings. Root fracture along with over and under obturation was noted under endodontics. Incidental findings under TMJ were flattening, erosion and bifid condyle. Enostosis and exostosis were noted under bone lesions. Tonsillolth, sialolith and calcified styloid ligament were noted under soft tissue calcifications. Incidental findings under others included foreign body, fused C1- C2 vertebrae, nutrient canals, and pneumatocyst. Maxillofacial radiologists should be aware of possible incidental findings and should be vigilant about comprehensively evaluating the entire captured volume, which can help in early diagnosis of any potential pathologies that may go undetected. Interpretation of CBCT is truly an art and with the experience, we can unravel the secrets hidden in the grey shades of the radiographic image.

Keywords: cone beam computed tomography, incidental findings, maxillofacial region, radiologist

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Authors: T. Almutairi, K. Naudi, N. Nairn, X. Ju, B. Eng, J. Whitters, A. Ayoub

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Purpose: At present Cone Beam Computed Tomography (CBCT) imaging does not record dental morphology accurately due to the scattering produced by metallic restorations and the reported magnification. The aim of this pilot study is the development and validation of a new method for the replacement of the distorted dentition of CBCT scans with the dental image captured by the digital intraoral camera. Materials and Method: Six dried skulls with orthodontics brackets on the teeth were used in this study. Three intra-oral markers made of dental stone were constructed which were attached to orthodontics brackets. The skulls were CBCT scanned, and occlusal surface was captured using TRIOS® 3D intraoral scanner. Marker based and surface based registrations were performed to fuse the digital intra-oral scan(IOS) into the CBCT models. This produced a new composite digital model of the skull and dentition. The skulls were scanned again using the commercially accurate Laser Faro® arm to produce the 'gold standard' model for the assessment of the accuracy of the developed method. The accuracy of the method was assessed by measuring the distance between the occlusal surfaces of the new composite model and the 'gold standard' 3D model of the skull and teeth. The procedure was repeated a week apart to measure the reproducibility of the method. Results: The results showed no statistically significant difference between the measurements on the first and second occasions. The absolute mean distance between the new composite model and the laser model ranged between 0.11 mm to 0.20 mm. Conclusion: The dentition of the CBCT can be accurately replaced with the dental image captured by the intra-oral scanner to create a composite model. This method will improve the accuracy of orthognathic surgical prediction planning, with the final goal of the fabrication of a physical occlusal wafer without to guide orthognathic surgery and eliminate the need for dental impression.

Keywords: orthognathic surgery, superimposition, models, cone beam computed tomography

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Authors: Babina Aryal

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Background: The diagnosis of pancreatitis is generally based on clinical and laboratory findings; however, Computed Tomography (CT) is an imaging technique of choice specially Contrast Enhanced Computed Tomography (CECT) shows morphological characteristic findings that allow for establishing the diagnosis of pancreatitis and determining the extent of disease severity which is done along with the administration of appropriate contrast medium. The purpose of this study was to compare Computed Tomography Dose Index (CTDI), Dose Length Product (DLP) and Effective Dose (ED) among male and female patients from Contrast Enhanced Computed Tomography (CECT) Pancreatitis Protocol. Methods: This retrospective study involved data collection based on clinical/laboratory/ultrasonography diagnosis of Pancreatitis and has undergone CECT Abdomen pancreatitis protocol. data collection involved detailed information about a patient's Age and Gender, Clinical history, Individual Computed Tomography Dose Index and Dose Length Product and effective dose. Results: We have retrospectively collected dose data from 150 among which 127 were males and 23 were females. The values obtained from the display of the CT screen were measured, calculated and compared to determine whether the CTDI, DLP and ED values were similar or not. CTDI for females was more as compared to males. The differences in CTDI values for females and males were 32.2087 and 37.1609 respectively. DLP values and Effective dose for both the genders did not show significant differences. Conclusion: This study concluded that there were no more significant changes in the DLP and ED values among both the genders however we noticed that female patients had more CTDI than males.

Keywords: computed tomography, contrast enhanced computed tomography, computed tomography dose index, dose length product, effective dose

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Authors: Chia-Hung Liao, Shih-Chieh Lin

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X-ray computed tomography (CT) technology has been used in the electronics industry as one of the non-destructive inspection tools for years. The key advantage of X-ray computed tomography technology superior to traditional optical inspection is the penetrating characteristics of X-rays can be used to detect defects in the interior of objects. The objective of this study is to find a way to estimate the system geometric deviation of X-ray CT equipment. Projection trajectories of the characteristic points of standard parts were tracked, and ways to calculate the deviation of various geometric parameters of the system will be proposed and evaluated. A simulation study will be conducted to first find out the effects of system geometric deviation on projected trajectories. Then ways to estimate geometric deviation with collected trajectories will be proposed and tested through simulations.

Keywords: geometric calibration, X-ray computed tomography, trajectory tracing, reconstruction optimization

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Authors: Fatima M. Jadu, Asmaa A. Alzahrani, Maha A. Almutairi, Salma O. Al-Amoudi, Mawya A. Khafaji

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Introduction: Estimating the potential radiation risk for a widely used imaging technique such as cone beam CT (CBCT) is crucial. The aim of this study was to examine the effect of varying two CBCT technical factors, the voxel size (VOX) and the Field-of-View (FOV) centralization, on the radiation dose. Methodology: The head and neck slices of a RANDO® man phantom (Alderson Research Laboratories) were used with nanoDot™ OSLD dosimeters to measure the absorbed radiation dose at 25 predetermined sites. Imaging was done using the i-CAT® (Imaging Science International, Hatfield, PA, USA) CBCT unit. The VOX was changed for every three cycles of exposures from 0.2mm to 0.3mm and then 0.4mm. Then the FOV was centered on the maxilla and mandible alternatively while holding all other factors constant. Finally, the effective radiation dose was calculated for each view and voxel setting. Results: The effective radiation dose was greatest when the smallest VOX was chosen. When the FOV was centered on the maxilla, the highest radiation doses were recorded in the eyes and parotid glands. While on the mandible, the highest radiation doses were recorded in the sublingual and submandibular glands. Conclusion: Minor variations in the CBCT exposure factors significantly affect the effective radiation dose and thus the radiation risk to the patient. Therefore, extreme care must be taken when choosing these parameters especially for vulnerable patients such as children.

Keywords: CBCT, cone beam CT, effective dose, field of view, mandible, maxilla, resolution, voxel

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Authors: Auwal Abubakar, Shazril Imran Shaukat, Noor Khairiah A. Karim, Mohammed Zakir Kassim, Gokula Kumar Appalanaido, Hafiz Mohd Zin

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Background: Voluntary deep inspiration breath-hold radiotherapy (vDIBH-RT) is an effective cardiac dose reduction technique during left breast radiotherapy. This study aimed to assess the accuracy of the implementation of the vDIBH technique among left breast cancer patients without the use of a special device such as a surface-guided imaging system. Methods: The vDIBH-RT technique was implemented among thirteen (13) left breast cancer patients at the Advanced Medical and Dental Institute (AMDI), Universiti Sains Malaysia. Breath-hold monitoring was performed based on breath-hold skin marks and laser light congruence observed on zoomed CCTV images from the control console during each delivery. The initial setup was verified using cone beam computed tomography (CBCT) during breath-hold. Each field was delivered using multiple beam segments to allow a delivery time of 20 seconds, which can be tolerated by patients in breath-hold. The data were analysed using an in-house developed MATLAB algorithm. PTV margin was computed based on van Herk's margin recipe. Results: The setup error analysed from CBCT shows that the population systematic error in lateral (x), longitudinal (y), and vertical (z) axes was 2.28 mm, 3.35 mm, and 3.10 mm, respectively. Based on the CBCT image guidance, the Planning target volume (PTV) margin that would be required for vDIBH-RT using CCTV/Laser monitoring technique is 7.77 mm, 10.85 mm, and 10.93 mm in x, y, and z axes, respectively. Conclusion: It is feasible to safely implement vDIBH-RT among left breast cancer patients without special equipment. The breath-hold monitoring technique is cost-effective, radiation-free, easy to implement, and allows real-time breath-hold monitoring.

Keywords: vDIBH, cone beam computed tomography, radiotherapy, left breast cancer

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Authors: Sung-Suk Oh, Bong-Keun Kang, Sang-Wook Park, Hui-Jin Joo, Jong-Ryul Choi, Seong-Jun Lee, Jeong-Woo Sohn

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The imaging phantom is utilized for the verification, evaluation and tuning of the medical imaging device and system. Although it could be costly, 3D printing is an ideal technique for a rapid, customized, multi-modal phantom making. In this article, we propose the multi-modal phantom using 3D printing. First of all, the Dicom images for were measured by CT (Computed Tomography) and 3D X-ray systems (PET/CT and Angio X-ray system of Siemens) and then were analyzed. Finally, the 3D modeling was processed using Dicom images. The 3D printed phantom was scanned by PET/CT and MRI systems and then evaluated.

Keywords: imaging phantom, MRI (Magnetic Resonance Imaging), PET / CT (Positron Emission Tomography / Computed Tomography), 3D printing

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Authors: Shirazu Issahaku, Isaac Kwesi Acquah, Simon Mensah Amoh, George Nunoo

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Introduction: Diagnostic Reference Levels are important indicators for monitoring and optimizing protocol and procedure in medical imaging between facilities and equipment. This helps to evaluate whether, in routine clinical conditions, the median value obtained for a representative group of patients within an agreed range from a specified procedure is unusually high or low for that procedure. This study aimed to propose Diagnostic Reference Levels for Computed Tomography examination of the most common routine examination of the head, chest and abdominal pelvis regions at the University of Ghana Medical Centre. Methods: The Diagnostic Reference Levels were determined based on the investigation of the most common routine examinations, including head Computed Tomography examination with and without contrast, abdominopelvic Computed Tomography examination with and without contrast, and chest Computed Tomography examination without contrast. The study was based on two dose indicators: the volumetric Computed Tomography Dose Index and Dose-Length Product. Results: The estimated median distribution for head Computed Tomography with contrast for volumetric-Computed Tomography dose index and Dose-Length Product were 38.33 mGy and 829.35 mGy.cm, while without contrast, were 38.90 mGy and 860.90 mGy.cm respectively. For an abdominopelvic Computed Tomography examination with contrast, the estimated volumetric-Computed Tomography dose index and Dose-Length Product values were 40.19 mGy and 2096.60 mGy.cm. In the absence of contrast, the calculated values were 14.65 mGy and 800.40 mGy.cm, respectively. Additionally, for chest Computed Tomography examination, the estimated values were 12.75 mGy and 423.95 mGy.cm for volumetric-Computed Tomography dose index and Dose-Length Product, respectively. These median values represent the proposed diagnostic reference values of the head, chest, and abdominal pelvis regions. Conclusions: The proposed Diagnostic Reference Level is comparable to the recommended International Atomic Energy Agency and International Commission Radiation Protection Publication 135 and other regional published data by the European Commission and Regional National Diagnostic Reference Level in Africa. These reference levels will serve as benchmarks to guide clinicians in optimizing radiation dose levels while ensuring accurate diagnostic image quality at the facility.

Keywords: diagnostic reference levels, computed tomography dose index, computed tomography, radiation exposure, dose-length product, radiation protection

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Authors: Aditi Jain

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Aim: To compare the canal transportation, centering ability and remaining dentin thickness of OneShape and WaveOne system using CBCT. Objective: To identify rotary system which respects original canal anatomy. Materials and Methods: Forty extracted human single-rooted premolars were used in the present study. Pre-instrumentation scans of all teeth were taken, canal curvatures were calculated, and the samples were randomly divided into two groups with twenty samples in each group, where Group 1 included WaveOne system and Group 2 Protaper rotary system. Post-instrumentation scans were performed, and the two scans were compared to determine canal transportation, centering ability and remaining dentin thickness at 1, 3, and 5 mm from the root apex. Results: Using Student’s unpaired t test results were as follows; for canal transportation Group 1 showed statistical significant difference at 3mm, 6mm and non-significant difference was obtained at 9mm but for Group 2 non-statistical significant difference was obtained at 3mm, 6mm, and 9mm. For centering ability and remaining dentin thickness Group 1 showed non-statistical significant difference at 3mm and 9mm, while statistical significant difference at 6mm was obtained. When comparison of remaining dentin thickness was done at three levels using two groups WaveOne and ProTaper. There was non-statistical significant difference between two groups. Conclusion: WaveOne single reciprocation file respects original canal anatomy better than ProTaper. WaveOne depicted the best centering ability.

Keywords: ShapeOne, WaveOne, transportation, centering ability, dentin thickness, CBCT (Cone Beam Computed Tomography)

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Authors: Diane Ghanem, Arjun Gupta, Rohan Vijayan, Ali Uneri, Babar Shafiq

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Introduction: Ankle sprains and fractures often result in syndesmosis injuries. Unstable syndesmotic injuries result from relative motion between the distal ends of the tibia and fibula, anatomic juncture which should otherwise be rigid, and warrant operative management. Clinical and radiological evaluations of intraoperative syndesmosis stability remain a challenging task as traditional 2D fluoroscopy is limited to a uniplanar translational displacement. The purpose of this pilot cadaveric study is to compare the 2D fluoroscopy and 3D cone beam computed tomography (CBCT) stress-induced syndesmosis displacements. Methods: Three fresh-frozen lower legs underwent 2D fluoroscopy and 3D CIOS CBCT to measure syndesmosis position before dissection. Syndesmotic injury was simulated by resecting the (1) anterior inferior tibiofibular ligament (AITFL), the (2) posterior inferior tibiofibular ligament (PITFL) and the inferior transverse ligament (ITL) simultaneously, followed by the (3) interosseous membrane (IOM). Manual external rotation and Cotton stress test were performed after each of the three resections and 2D and 3D images were acquired. Relevant 2D and 3D parameters included the tibiofibular overlap (TFO), tibiofibular clear space (TCS), relative rotation of the fibula, and anterior-posterior (AP) and medial-lateral (ML) translations of the fibula relative to the tibia. Parameters were measured by two independent observers. Inter-rater reliability was assessed by intraclass correlation coefficient (ICC) to determine measurement precision. Results: Significant mismatches were found in the trends between the 2D and 3D measurements when assessing for TFO, TCS and AP translation across the different resection states. Using 3D CBCT, TFO was inversely proportional to the number of resected ligaments while TCS was directly proportional to the latter across all cadavers and ‘resection + stress’ states. Using 2D fluoroscopy, this trend was not respected under the Cotton stress test. 3D AP translation did not show a reliable trend whereas 2D AP translation of the fibula was positive under the Cotton stress test and negative under the external rotation. 3D relative rotation of the fibula, assessed using the Tang et al. ratio method and Beisemann et al. angular method, suggested slight overall internal rotation with complete resection of the ligaments, with a change < 2mm - threshold which corresponds to the commonly used buffer to account for physiologic laxity as per clinical judgment of the surgeon. Excellent agreement (>0.90) was found between the two independent observers for each of the parameters in both 2D and 3D (overall ICC 0.9968, 95% CI 0.995 - 0.999). Conclusions: The 3D CIOS CBCT appears to reliably depict the trend in TFO and TCS. This might be due to the additional detection of relevant rotational malpositions of the fibula in comparison to the standard 2D fluoroscopy which is limited to a single plane translation. A better understanding of 3D imaging may help surgeons identify the precise measurements planes needed to achieve better syndesmosis repair.

Keywords: 2D fluoroscopy, 3D computed tomography, image processing, syndesmosis injury

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Authors: Saghar Karimi, Mohammad Saeed Ahrari Khafi, Amin Abolhasani Foroughi

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In recent decades, keeping exotic species as pet animals has become widespread. Turtles are exotic species from chelonians, which are interested by many people. Caspian pond and European pond turtles from Emydidea family are commonly kept as pets in Iran. Presence of the shell in turtles makes achievement to a comprehensive clinical examination impossible. Respiratory system is one of the most important structures to be examined completely. Presence of the air in the respiratory system makes radiography the first modality to think of; however, image quality would be affected by the shell. Computed tomography (CT) as a radiography-based and non-invasive technique provides cross-sectional scans with little superimposition. The aim of this study was to depict normal computed tomographic anatomy of the respiratory system in Caspian Pond Turtle. Five adult Caspian pond turtle were scanned using a 16-detector CT machine. Our results showed that computed tomography is able to well illustrated different parts of respiratory system in turtle and can be used for detecting abnormalities and disorders.

Keywords: anatomy, computed tomography, respiratory system, turtle

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Authors: Jorge Martinez-Garcia, Ingrid Stelzner, Joerg Stelzner, Damian Gwerder, Philipp Schuetz

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Tree-ring analysis is an important part of the quality assessment and the dating of (archaeological) wood samples. It provides quantitative data about the whole anatomical ring structure, which can be used, for example, to measure the impact of the fluctuating environment on the tree growth, for the dendrochronological analysis of archaeological wooden artefacts and to estimate the wood mechanical properties. Despite advances in computer vision and edge recognition algorithms, detection and counting of annual rings are still limited to 2D datasets and performed in most cases manually, which is a time consuming, tedious task and depends strongly on the operator’s experience. This work presents an image processing approach to detect the whole 3D tree-ring structure directly from X-ray computed tomography imaging data. The approach relies on a modified Canny edge detection algorithm, which captures fully connected tree-ring edges throughout the measured image stack and is validated on X-ray computed tomography data taken from six wood species.

Keywords: ring recognition, edge detection, X-ray computed tomography, dendrochronology

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Authors: Mahkameh Asadi, Habibollah Dadgar

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The precise definition margin of high and low-grade glioma is crucial for choosing best treatment approach after surgery and radio-chemotherapy. The aim of the current study was to assess the O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) positron emission tomography (PET)/computed tomography (CT) in patients with low (LGG) and high grade glioma (HGG). We retrospectively analyzed 18F-FET PET/CT of 10 patients (age: 33 ± 12 years) with suspicious for recurrent LGG and HGG. The final decision of recurrence was made by magnetic resonance imaging (MRI) and registered clinical data. While response to radio-chemotherapy by MRI is often complex and sophisticated due to the edema, necrosis, and inflammation, emerging amino acid PET leading to better interpretations with more specifically differentiate true tumor boundaries from equivocal lesions. Therefore, integrating amino acid PET in the management of glioma to complement MRI will significantly improve early therapy response assessment, treatment planning, and clinical trial design.

Keywords: positron emission tomography, amino acid positron emission tomography, magnetic resonance imaging, low and high grade glioma

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Authors: Liyun Chang, Cheng-Hsiang Tsai

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To ensure the radiation precisely delivering to the target of cancer patients, the linear accelerator equipped with the pretreatment on-board imaging system is introduced and through it the patient setup is verified before the daily treatment. New generation radiotherapy using beam-intensity modulation, usually associated the treatment with steep dose gradients, claimed to have achieved both a higher degree of dose conformation in the targets and a further reduction of toxicity in normal tissues. However, this benefit is counterproductive if the beam is delivered imprecisely. To avoid shooting critical organs or normal tissues rather than the target, it is very important to carry out the quality assurance (QA) of this on-board imaging system. The QA of the On-Board Imager® (OBI) system of one Varian Clinac-iX linear accelerator was performed through our procedures modified from a relevant report and AAPM TG142. Two image modalities, 2D radiography and 3D cone-beam computed tomography (CBCT), of the OBI system were examined. The daily and monthly QA was executed for five months in the categories of safety, geometrical accuracy and image quality. A marker phantom and a blade calibration plate were used for the QA of geometrical accuracy, while the Leeds phantom and Catphan 504 phantom were used in the QA of radiographic and CBCT image quality, respectively. The reference images were generated through a GE LightSpeed CT simulator with an ADAC Pinnacle treatment planning system. Finally, the image quality was analyzed via an OsiriX medical imaging system. For the geometrical accuracy test, the average deviations of the OBI isocenter in each direction are less than 0.6 mm with uncertainties less than 0.2 mm, while all the other items have the displacements less than 1 mm. For radiographic image quality, the spatial resolution is 1.6 lp/cm with contrasts less than 2.2%. The spatial resolution, low contrast, and HU homogenous of CBCT are larger than 6 lp/cm, less than 1% and within 20 HU, respectively. All tests are within the criteria, except the HU value of Teflon measured with the full fan mode exceeding the suggested value that could be due to itself high HU value and needed to be rechecked. The OBI system in our facility was then demonstrated to be reliable with stable image quality. The QA of OBI system is really necessary to achieve the best treatment for a patient.

Keywords: CBCT, image quality, quality assurance, OBI

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Authors: Zain Khan, Steve Ahn, Kathy Monypenny, James Fink

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In Australian public hospitals, there were approximately 34,000 reported inpatient falls between 2015 to 2016. The gold standard for diagnosing intracranial injury is non-contrast enhanced brain computed tomography (CTB). Over a three-month timeframe, a total of one hundred and eighty (180) falls were documented between the hours of 4pm and 8am at a large metro hospital. Only three (3) of these scans demonstrated a positive intra-cranial finding. The rationale for scanning varied. The common indications included a fall with head strike, the presence of blood thinning medication, loss of consciousness, reduced Glasgow Coma Scale (GCS), vomiting and new neurological findings. There are several validated tools to aid in decision-making around ordering CTB scans in the acute setting, but no such accepted tool exists for the inpatient space. With further data collection, spanning a greater length of time and through involving multiple centres, work can be done towards generating such a tool that can be utilized for inpatient falls.

Keywords: computed tomography, falls, inpatient, intracranial hemorrhage

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Authors: Verena M. Moock, Darien E. Arce Chávez, Mariana M. Espejel González, Leopoldo Ruíz-Huerta, Crescencio García-Segundo

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Uncertainty analysis in industrial computed tomography is commonly related to metrological trace tools, which offer precision measurements of external part features. Unfortunately, there is no such reference tool for internal measurements to profit from the unique imaging potential of X-rays. Uncertainty approximations for computed tomography are still based on general aspects of the industrial machine and do not adapt to acquisition parameters or part characteristics. The present study investigates the impact of the acquisition time on the dimensional uncertainty measuring a stainless steel cylinder with a circular tomography scan. The authors develop the figure difference method for X-ray radiography to evaluate the volumetric differences introduced within the projected absorption maps of the metal workpiece. The dimensional uncertainty is dominantly influenced by photon energy dissipated as heat causing the thermal expansion of the metal, as monitored by an infrared camera within the industrial tomograph. With the proposed methodology, we are able to show evolving temperature differences throughout the tomography acquisition. This is an early study showing that the number of projections in computer tomography induces dimensional error due to energy absorption. The error magnitude would depend on the thermal properties of the sample and the acquisition parameters by placing apparent non-uniform unwanted volumetric expansion. We introduce infrared imaging for the experimental display of metrological uncertainty in a particular metal part of symmetric geometry. We assess that the current results are of fundamental value to reach the balance between the number of projections and uncertainty tolerance when performing analysis with X-ray dimensional exploration in precision measurements with industrial tomography.

Keywords: computed tomography, digital metrology, infrared imaging, thermal expansion

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Authors: Sajid Abas, Jon Pyo Hong, Jung-Ryun Le, Seungryong Cho

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Computed tomography and laminography are heavily investigated in a compressive sensing based image reconstruction framework to reduce the dose to the patients as well as to the radiosensitive devices such as multilayer microelectronic circuit boards. Nowadays researchers are actively working on optimizing the compressive sensing based iterative image reconstruction algorithm to obtain better quality images. However, the effects of the sampled data’s properties on reconstructed the image’s quality, particularly in an insufficient sampled data conditions have not been explored in computed laminography. In this paper, we investigated the effects of two data properties i.e. sampling density and data incoherence on the reconstructed image obtained by conventional computed laminography and a recently proposed method called spherical sinusoidal scanning scheme. We have found that in a compressive sensing based image reconstruction framework, the image quality mainly depends upon the data incoherence when the data is uniformly sampled.

Keywords: computed tomography, computed laminography, compressive sending, low-dose

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Authors: A. Ikhlef

Abstract:

Image noise in computed tomography, is mainly caused by the statistical noise, system noise reconstruction algorithm filters. Since last few years, low dose x-ray imaging became more and more desired and looked as a technical differentiating technology among CT manufacturers. In order to achieve this goal, several technologies and techniques are being investigated, including both hardware (integrated electronics and photon counting) and software (artificial intelligence and machine learning) based solutions. From a hardware point of view, electronic noise could indeed be a potential driver for low and ultra-low dose imaging. We demonstrated that the reduction or elimination of this term could lead to a reduction of dose without affecting image quality. Also, in this study, we will show that we can achieve this goal using conventional electronics (low cost and affordable technology), designed carefully and optimized for maximum detective quantum efficiency. We have conducted the tests using large imaging objects such as 30 cm water and 43 cm polyethylene phantoms. We compared the image quality with conventional imaging protocols with radiation as low as 10 mAs (<< 1 mGy). Clinical validation of such results has been performed as well.

Keywords: computed tomography, electronic noise, scintillation detector, x-ray detector

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Authors: C. G. Jinimole, A. Harsha

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One of the key problems facing in the analysis of Computed Tomography (CT) images is the poor contrast of the images. Image enhancement can be used to improve the visual clarity and quality of the images or to provide a better transformation representation for further processing. Contrast enhancement of images is one of the acceptable methods used for image enhancement in various applications in the medical field. This will be helpful to visualize and extract details of brain infarctions, tumors, and cancers from the CT image. This paper presents a comparison study of five contrast enhancement techniques suitable for the contrast enhancement of CT images. The types of techniques include Power Law Transformation, Logarithmic Transformation, Histogram Equalization, Contrast Stretching, and Laplacian Transformation. All these techniques are compared with each other to find out which enhancement provides better contrast of CT image. For the comparison of the techniques, the parameters Peak Signal to Noise Ratio (PSNR) and Mean Square Error (MSE) are used. Logarithmic Transformation provided the clearer and best quality image compared to all other techniques studied and has got the highest value of PSNR. Comparison concludes with better approach for its future research especially for mapping abnormalities from CT images resulting from Brain Injuries.

Keywords: computed tomography, enhancement techniques, increasing contrast, PSNR and MSE

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Authors: Qasem A. Alyazji

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One of the main techniques for Positron emission tomography (PET), Single photon emission computed tomography (SPECT) is the development of radiation detectors. The NaI(Tl) scintillator crystal coupled to an array of photomultiplier tubes known as the Anger camera, is the most dominant detectors system in PET and SPECT devices. Technological advances in many materials, in addition to the emerging importance of specialized applications such as preclinical imaging and cardiac imaging, have encouraged innovation so that alternatives to the anger camera are now part in alternative imaging systems. In this paper we will discuss the main performance characteristics of detectors devices and scanning developments in both scintillation detectors, semiconductor (solid state) detectors, and Photon Transducers such as photomultiplier tubes (PMTs), position sensitive photomultiplier tubes (PSPMTs), Avalanche photodiodes (APDs) and Silicon photomultiplier (SiPMT). This paper discussed the detectors that showed promising results. This study is a review of recent developments in the detectors used in single photon emission computed tomography (SPECT) imaging system.

Keywords: SPECT, scintillation, PMTs, SiPMT, PSPMTs, APDs, semiconductor (solid state)

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Authors: Alyona Gencheva

Abstract:

The most common way to study diagnostic results is using specialized programs at a stationary workplace. Magnetic Resonance Imaging is presented in a two-dimensional (2D) format, and Computed Tomography sometimes looks like a three-dimensional (3D) model that can be interacted with. The main idea of the research is to compare ways of displaying diagnostic results in virtual reality that can help a surgeon during or before an operation in augmented reality. During the experiment, the medical staff examined liver vessels in the abdominal area and heart boundaries. The search time and detection accuracy were measured on black-and-white and coloured scans. Usability testing in virtual reality shows convenient ways of interaction like hand input, voice activation, displaying risk to the patient, and the required number of scans. The results of the experiment will be used in the new C# program based on Magic Leap technology.

Keywords: augmented reality, computed tomography, magic leap, magnetic resonance imaging, usability testing, VTE risk

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Authors: C. Gopi Jinimole, A. Harsha

Abstract:

For detecting strokes, Computed Tomography (CT) scan is preferred for imaging the abnormalities or infarction in the brain. Because of the problems in the window settings used to evaluate brain CT images, they are very poor in the early stage infarction detection. This paper presents an automatic estimation method for the window settings of the CT images for proper contrast of the hyper infarction present in the brain. In the proposed work the window width is estimated automatically for each slice and the window centre is changed to a new value of 31HU, which is the average of the HU values of the grey matter and white matter in the brain. The automatic window width estimation is based on the average of median of statistical central moments. Thus with the new suggested window centre and estimated window width, the hyper infarction or post-stroke regions in CT brain images are properly detected. The proposed approach assists the radiologists in CT evaluation for early quantitative signs of delayed stroke, which leads to severe hemorrhage in the future can be prevented by providing timely medication to the patients.

Keywords: computed tomography (CT), hyper infarction or post stroke region, Hounsefield Unit (HU), window centre (WC), window width (WW)

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Authors: Okhee Woo

Abstract:

Purpose: The aim of this study is to evaluate 2-year cumulative effective radiation dose and cumulative organ dose on regular follow-up computed tomography (CT) scans in patients with breast cancer and to establish personalized low-dose CT protocol. Methods and Materials: A retrospective study was performed on the patients with breast cancer who were diagnosed and managed consistently on the basis of routine breast cancer follow-up protocol between 2012-01 and 2016-06. Based on ICRP (International Commission on Radiological Protection) 103, the cumulative effective radiation doses of each patient for 2-year follow-up were analyzed using the commercial radiation management software (Radimetrics, Bayer healthcare). The personalized effective doses on each organ were analyzed in detail by the software-providing Monte Carlo simulation. Results: A total of 3822 CT scans on 490 patients was evaluated (age: 52.32±10.69). The mean scan number for each patient was 7.8±4.54. Each patient was exposed 95.54±63.24 mSv of radiation for 2 years. The cumulative CT radiation dose was significantly higher in patients with lymph node metastasis (p = 0.00). The HER-2 positive patients were more exposed to radiation compared to estrogen or progesterone receptor positive patient (p = 0.00). There was no difference in the cumulative effective radiation dose with different age groups. Conclusion: To acknowledge how much radiation exposed to a patient is a starting point of management of radiation exposure for patients with long-term CT follow-up. The precise and personalized protocol, as well as iterative reconstruction, may reduce hazard from unnecessary radiation exposure.

Keywords: computed tomography, breast cancer, effective radiation dose, cumulative organ dose

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