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Performance Cone-Beam Ct of the Head

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Performance Cone-Beam Ct of the Head IMAGE QUALITY, MODELING, AND DESIGN FOR HIGH- PERFORMANCE CONE-BEAM CT OF THE HEAD by Jennifer Xu A dissertation submitted to Johns Hopkins University in conformity with the requirements for the degree of Doctor of Philosophy Baltimore, Maryland December, 2016 © Jennifer Xu 2016 All rights reserved Abstract Diagnosis and treatment of neurological and otolaryngological diseases rely heavily on visualization of fine, subtle anatomical structures in the head. In particular, high-quality head imaging at the point of care mitigates patient risk associated with transport and decreases time to diagnosis for time-sensitive diseases. Cone-beam computed tomography (CBCT) systems have found widespread adoption in diagnostic and image-guided procedures. Such systems exhibit potential for adaptation as point-of-care systems due to relatively low cost, mechanical simplicity, and inherently high spatial resolution, but are generally challenged by low contrast imaging tasks (e.g., visualization of tumors or hemorrhages). This thesis details the development and design of a CBCT imaging system with performance sufficient for high-quality imaging of the head and suitable to deployment at the point of care. The performance of a commercially available head-and-neck CBCT scanner was assessed to determine the potential of such systems for high-quality head imaging. Results indicated low-contrast visualization was challenged by high detector noise and scatter. Photon counting x-ray detectors (PCDs) were identified as a potential technology that could improve the low-contrast visualization, and an imaging performance model was developed to quantify their imaging performance. The model revealed important implications for energy resolution, noise, and spatial resolution as a function of energy threshold and charge sharing rejection. A new CBCT system dedicated to detection of low-contrast contrast intracranial hemorrhage was designed with guidance from an imaging chain model to optimize the system configuration (geometry, detector, x-ray source, etc.). The results indicated flat panel detectors (FPDs) were favorable due to a large field of view, but benefited from detector readout gain adjustments. Dual-gain detector readout was compared with use of bowtie filter in high-gain readout mode to investigate potential improvements to noise performance in FPDs. Finally, technical assessment of the prototype CBCT head scanner (with design based on guidance from the image quality model) indicated performance suitable for translation to clinical studies in the neurosciences critical care unit. ii Readers Jeffrey H. Siewerdsen, Ph.D. (advisor) Professor, Department of Biomedical Engineering Johns Hopkins University Katsuyuki Taguchi, Ph.D. Assistant Professor, Russell H. Morgan Department of Radiology Johns Hopkins University J. Webster Stayman, Ph.D. Assistant Professor, Department of Biomedical Engineering Johns Hopkins University Nafi Aygun, M.D. Associate Professor, Russell H. Morgan Department of Radiology Johns Hopkins University iii There is shadow under this red rock, (Come in under the shadow of this red rock), And I will show you something different from either Your shadow at morning striding behind you Or your shadow at evening rising to meet you… -T.S. Eliot, The Wastelands iv Acknowledgments First, I would like to thank my advisor, Jeffrey Siewerdsen, for his seemingly tireless efforts in shaping my graduate experience. Without his lofty goals, his incredible dedication to teaching and mentoring, and the intense pressure he applies to both himself and everyone around him, I would still be a lump of coal at the bottom of the well. Additionally, a huge thanks to my mentor and bike commuting leader Wojtek for showing me how to enjoy the pursuit of scientific excellence without taking myself too seriously—and also for introducing me to the afternoon espresso break. He is truly an incredible scientist-engineer and a genuinely good person, too. To Web goes thanks for being a fount of information for all things reconstruction. I have a tremendous amount of respect for my friends, colleagues, and role models in the iStar and AIAI labs: Saj and Sebastian—making science look good, one picture at a time; Adam, for being nice enough to tolerate all my stupid questions and for passing on the Jello lore; Alejandro, for always being the responsible adult (and also contributing the MC dose simulation code in Chapter 5); Amir, of the well-lit methods pictures, for being possibly the only person who makes more inappropriate jokes than me; Qian, Tharindu, and Hao, my tennis buddies—also, swirly frosting, cake, and bunnies; Michael Ketcha, a most dapper dresser, pun artist, and fellow foam enthusiast; Sarah, Ja, and Esme, for being strong women who know their own minds; and everybody else in the lab, for making these last few years a most enjoyable experience. Of course, these people are also extraordinary scientists and inspire me on a daily basis to push myself to even higher achievement. The work presented in this thesis was not performed in a vacuum, and a number of collaborators contributed their time, expertise, and resources: my rotation advisor, Ken Taguchi, whose insightful comments and expertise on photon counting detectors helped inform the work in Chapter 3; Erik Fredenberg and Mats Lundqvist, whose collective expertise was invaluable in understanding the electronics and physics of silicon strip photon counting detectors; Ed Wang, Ian Yorkston, Nathan Packard, Bill Snyder, Dave Foos, and Sam Richard for their incredible hospitality while I was visiting Rochester and their tremendous support for the head scanner project; and our clinical collaborators, Doug Reh, John Carey, John Carrino, Vassillis Koliatsos, and Nafi Aygun, who help define the problems and assess our solutions in everyday practice. v For my family: my grandmother, who came all the way to America just to make sure a gangly five- year-old could survive in a completely foreign environment and my grandfather, who fostered a hunger for knowledge with his tales of exploration and discovery. A special thanks to my parents, for all the bitter medicine administered during my childhood in preparation for a brighter future, and all the sacrifice that entailed. Your lessons kept me humble, and your ambitions for the future fueled my pursuit of success. I hope I have not disappointed. To my extended family, the Lazear-Leamon conglomerate, thank you for welcoming me into the fold as if I were one of your own, with warmth and unexpected eagerness—surely it wasn’t that shocking for Justin to want to go to prom! Finally, my husband—to whom this thesis is dedicated—has been my trailblazer through life since I first met him (even after I insisted I was smarter than he was), leading by example and lending me courage to overcome my fears and insecurities. Without his annoyingly insightful questions about my work, my understanding of science and technology would not be as complete. Without his witty repartee, my nights would be that much darker. Most of all, without him, going home at the end of the day would just not be the same. vi Dedication: For Justin. vii Contents ABSTRACT ............................................................................................................................................... II CHAPTER 1: INTRODUCTION ............................................................................................................. 1 I. X-RAY IMAGING PHYSICS ................................................................................................................. 1 I.A X-Ray Generation .................................................................................................................. 1 I.B X-Ray Interactions with Matter .............................................................................................. 2 I.C X-Ray Detection ..................................................................................................................... 3 I.D X-Ray Detector Technologies ................................................................................................ 5 II. COMPUTED TOMOGRAPHY ............................................................................................................... 7 II.A Transmission X-Ray CT Systems .......................................................................................... 7 II.B Reconstruction and Algorithms ............................................................................................ 8 III. X-RAY IMAGING SYSTEM PERFORMANCE .................................................................................... 11 III.A Spatial Resolution ............................................................................................................. 11 III.B Noise .................................................................................................................................. 12 III.C Propagation of Signal and Noise ...................................................................................... 14 III.D Imaging Performance Metrics and Detectability .............................................................. 14 III.E Artifacts ............................................................................................................................. 15 IV. CLINICAL MOTIVATION ................................................................................................................ 17 IV.A Clinical Applications for Head Imaging with X-Ray CT ..................................................
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