Workshop Summary

Anthony Butler Radiologist and Physicist Disclaimer

I have many biases - I am a clinician by job and physicist by hobby - My university has been a member of Medipix since 2006 - I am a founder of MARS Bioimaging Ltd Overview

 Participants and submissions

 Context

 Review of talks

 Conclusions Disclaimer

NZ has a strange view of the world Disclaimer

NZ has a strange view of the world  Participants

 Context

 Review of talks

 Conclusions Scientific committee

Michael Campbell, CERN

Anthony Butler, Univ. of Canterbury & MARS Bioimaging

Steffen Kappler, Siemens Healthineers

Ewald Roessl, Philips Research Laboratories

Katsuyuki (Ken) Taguchi, Johns Hopkins University

Richard Thompson, Canon Medical Research

Brian Yanoff, GE Global Research

… with lots of assistance from Patricia Mage-Granados

Initiation only for several reasons Participants 119 registrants

2017 => 130 2013 => 102 2015 => 112 2011 => 76

50 Industry; 46 Scientists; 23 Medical >85% are returning guests  Participants and submissions

 Context

 Review of talks

 Conclusions Context The electromagnetic spectrum

X-ray colour: Wavelength, Frequency, or Energy Context

Spectral CT is true colour x-ray imaging Context

Hounsfield, Nobel Prize 1979

Computed Tomography is 3D X-rays Context

300,000,000 people per year get a CT

Hounsfield, Nobel Prize 1979

Computed Tomography is 3D X-rays Context

Rontgen 1895, to CERN technology 2018 Context Before SpecXray

Earnest Rutherford:

We have no money, therefore we must think

Particle physics pushes frontiers of knowledge Context Before SpecXray

Early ’80s, direct Si detectors – Erik Heijne, Robert Klanner, Gehard Lutz

Their role is recognized by the 2017 High Energy and Particle Physics Prize of EPS

Mid ’90s, Medipix – Michael Campbell “Various applications like Medical Imaging should profit” Context SpecXray 2011

Mouse, Mouse, Human, Anthony Butler Ewald Roessel Jerry Arenson

MARS, Philips, and GE Healthcare Context 2011 to 2019 PCD 2017

2011

Rajiv Gupta, Mass.Gen.Hosp Context 2011 to 2019 PCD 2017

2011 2013-2017

Rajiv Gupta, Mass.Gen.Hosp Context 2011 to 2019 PCD 2017

2011 2013-2017 2019

Rajiv Gupta, Mass.Gen.Hosp Context The world has changed

More focus on value, not excellence … … scanners for emerging markets … United Imaging Ltd … health-pathways and efficient care

Radiology market has changed Context The world has changed

More focus on value, not excellence … … scanners for emerging markets … United Imaging Ltd … health-pathways and efficient care

Earlier decision making… … growth of Urgent and Point-of-Care … Artificial Intelligence

Radiology market has changed I’m lucky if I can learn one thing per talk

 Participants

 Context

 Review of talks

 Conclusions Invited talk

A patient in Tuba City, Arizona (Navajo Nation), 5hr drive from Albuquerque

Scanners with no moving parts in order to meet the community’s needs

Re-imagining the imaging system Rajiv Gupta, Mass.Gen.Hosp Invited talk

Image processing is a critical part of the system

Reimaging the imaging system Rajiv Gupta, Mass.Gen.Hosp Taking it to humans

The world is watching Anthony Butler, Uni. Of Canterbury Taking it to humans

Imaging where the clinician wants to see

Universal protocols practical for users

Strong focus on clinical benefits Cynthia McCollough, Mayo Clinic Clinical applications

PCD

EID Multiple image metrics showing PCD gives better image quality

Photon counting gives better image quality Jayasai Rajagopol, NIH Clinical Centre Clinical applications

Image quality

=

Can I make a diagnosis?

Need to assist clinicians Thorsten Fleiter, Uni. of Maryland Clinical applications

Iodine and Bismuth used simultaneously ( animal models of tumors )

Multiple contrast agents for radiological surgery William Pritchard, NIH Clinical Centre Clinical applications

Structure and mineralization Gout Micro-fractures

Lots of easily accessible bone applications Aamir Raja, Uni. of Otago Prototype systems

Building systems is hard!

Showed complexity of systems Pete Edic, GE Global Research Prototype systems

Protocols vary, but potentially big dose advantages

PCT allows high resolution and low dose Shuai Leng, Mayo Clinic Prototype systems

2 sources + 2 bin detectors = 4 energies

Number of bins and energy separation is critical Shuai Leng, Mayo Clinic Detector systems

Gd/Ho K-edges: 6 keV apart

Very close materials can be separated Magdalena Bazalova-Carter, Uni. of Victoria Detector systems

1 mm CdTe

Internal Escape XRF peak

Improved spectral resolution Improved spatial resolution

Timepix3 is a REALLY advanced detector Jan Jakubek, ADVACAM Detector systems

Singe chip Compton camera for thyroid Jan Jakubek, ADVACAM Detector systems

4 side buttable, 5 energy, high flux

Kris also talked about who might benefit from spectral imaging

CZT and commercial detectors have improved Kris Iniewski, Redlen Technologies Lots of time for discussion

Coppet and its chateau Thanks to Michael and Patricia Detector modelling

Charge transport over time Yi Qiang, Cannon Medical Research Simulations and Recon

…. may be enough to get good images

Just measure co-incident, but don’t correct Scott Hsieh, UCLA Simulations and Recon

Spectral phase contrast – an important future Thorsten Sellerer, Technical Uni. Munich Simulations and Recon

What is the optimal basis for describing tissues?

Spectra -> Eigen-basis -> Materials

Eigen-tissue decomposition Mikael Simard, Uni. of Montreal Detectors of HEP

Very clear description of LHC, ATLAS, and CMS Walter Snoeys, CERN Molecular imaging

Two contrast agents - tumor vascularization - nano-particle distribution

Nano-particles are used in cancer research Ananth Annapragada, Baylor College Molecular imaging Ex-vivo imaging means he knows what he wants to see in humans

Cardiovascular disease causes 37% of EU deaths Steven Gieseg, Uni. Canterbury Material Decomposition

Improvements in projection based MD Artur Sossin, Philips Innovative Technology Material Decomposition

More flexible: - apply image constrains - variable energy bins - non-ideal detectors - flux dependent effects - variable input spectra Projections Materials

One step reconstruction and MD Taly Schmidt, Marquette Uni. High-Z semi-conductors

Instability more noticeable at high energy thresholds

Th1 Th2 Th3 Th4 Th5

Stability counts

>200 Mcps/mm2 Integrated achievable!

High photon flux is a challenge Georgios Prekas, Redlen Technology ASICs

Excellent for pushing the limits of spectral x-ray technology

65nm technology Pixel matrix of 512 x 448 pixels (55 µm x 55 µm) Particle identification and tracking (Data driven) Imaging (frame based with CRW sequential readout) Sub-ns time binning  ~195ps Max data output ≤163.84 Gbps Energy resolution  <1 KeV 4 side buttable due to TSV

Timepix4 is almost here Xavi Llopart, CERN ASICs

Increase detector area for real clinical CTs

TSV

New 4 side buttable ASIC for CT Edgar Goederer, Siemens Healthineers ASICs

Increase detector area for real clinical CTs

New 4 side buttable ASIC for CT Edgar Goederer, Siemens Healthineers ASICs

Charging sharing and pulse pile-up are the main challenges

Charge sharing correction scheme Pawl Grybos, AGH Uni.of Science and Technology ASICs

Want to have: charge sharing correction, pile-up correction, more energies Currently: Future:

2 energies Pile-up rejection Charge sharing correction 256 energy bins-real time 2 side “buttable” Energy resolution 7 to 9% OCR= 8 Mcps/pixel https://ctcicblog.mayo.edu/hubca https://www.nih.gov/news-events/news-releases/nih-uses-photon-counting-ct-scanner-patients-first-time p/our-scanners/

Moving beyond 2 energies for clinical CT Loick Verger, CEA LETI ASICs My favorite talk !

A great review of competing requirements Rafael Ballabriga, CERN  Participants

 Context

 Review of talks

 Conclusions Conclusion

“This is what happens when you bring people with good ideas together to form a community”

Stephan Kappler, Scientific committee Conclusion

Looking back what have we learned since 2011? The medical applications of spectral x-ray detectors are: - new information - higher resolution - lower dose Conclusion

Looking back what have we learned since 2011? The medical applications of spectral x-ray detectors are: - new information - higher resolution - lower dose

2011 – would any of this work? Conclusion

What have we learned in this workshop? Spectral CT is going to happen - all of the challenges are successfully being address - it will reach the clinics (timelines remain uncertain)

At least 300,000,000 people per year will benefit Thanks you

Michael Campbell, CERN

Anthony Butler, Univ. of Canterbury & MARS Bioimaging

Steffen Kappler, Siemens Healthineers

Ewald Roessl, Philips Research Laboratories

Katsuyuki (Ken) Taguchi, Johns Hopkins University

Richard Thompson, Canon Medical Research

Brian Yanoff, GE Global Research