Classification of X-Ray Attenuation Properties of Additive Manufacturing and 3D Printing Materials Using Computed Tomography From 70 to 140 kVp

Additive manufacturing and 3D printing is particularly useful in the production of phantoms for medical imaging applications including determination and optimization of (diagnostic) image quality and dosimetry. Additive manufacturing allows the leap from simple slab and stylized to (pseudo)-anthropomorphic phantoms. This necessitates the use of materials with x-ray attenuation as close as possible to that of the tissues or organs mimicked. X-ray attenuation properties including their energy dependence were determined for 35 printing materials comprising photocured resins and thermoplastic polymers. Prior to measuring x-ray attenuation in CT from 70 to 140 kVp, printing parameters were thoroughly optimized to ensure maximum density avoiding too low attenuation due to microscopic or macroscopic voids. These optimized parameters are made available. CT scanning was performed in a water filled phantom to guarantee defined scan conditions and accurate HU value determination. The spectrum of HU values covered by polymers printed using fused deposition modeling reached from −258 to +1,063 at 120 kVp (−197 to +1,804 at 70 kVp, to −266 to +985 at 140 kVp, respectively). Photocured resins covered 43 to 175 HU at 120 kVp (16–156 at 70, and 57–178 at 140 kVp). At 120 kVp, ASA mimics water almost perfectly (+2 HU). HIPS (−40 HU) is found close to adipose tissue. In all photocurable resins, and 17 printing filaments HU values decreased with increasing beam hardness contrary to soft tissues except adipose tissue making it difficult to mimic water or average soft tissue in phantoms correctly over a range of energies with one single printing material. Filled filaments provided both, the HU range, and an appropriate energy dependence mimicking bone tissues. A filled material with almost constant HU values was identified potentially allowing mimicking soft tissues by reducing density using controlled under-filling. The measurements performed in this study can be used to design phantoms with a wide range of x-ray contrasts, and energy dependence of these contrasts by combining appropriate materials. Data provided on the energy dependence can also be used to correct contrast or contrast to noise ratios from phantom measurements to real tissue contrasts or CNRs.

The Impact of Different Types of Orthodontic Appliances and Its Location in Producing CT Scan Artefacts

Fixed orthodontic appliances can produce metal artefacts in CT images which may degrade the diagnostic image quality. The study aimed to evaluate the artefacts based on the types and location of the metallic and non-metallic orthodontic brackets. This is an in-vitro cross-sectional study. Four different types of orthodontic brackets (stainless steel, titanium, monocrystalline, and polycrystalline ceramic bracket) were bonded consecutively in four different locations of the cadaveric skull. All scans were performed by a single operator using the same CT machine followed by a standard scanning protocol. Artefact intensity for all data sets was quantified by calculating the standard deviation (SD) of the grey values within the dataset by following a standard method. The One-way ANOVA Bonferroni test was used for the data analysis. The mean artefact score of the stainless steel bracket was significantly (p < 0.001) high in comparison with other types of the orthodontic brackets. Besides, the mean artefact score was significantly (p=0.002) low when orthodontic brackets were placed unilaterally. Stainless steel brackets produced a significant amount of noise in CT images which can degrade the diagnostic image quality. Thus, the polycrystalline ceramic bracket can be a better alternative of stainless steel brackets for patient need frequent CT scan.

Rising utilization of coronary CT angiography across Europe over the last decade: insights from a large prospective European registry

Background/Introduction The recently updated 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes endorse the use of coronary computed tomography angiography (CCTA) for exclusion of obstructive coronary artery disease in patients with a low clinical likelihood (Class I, LOE B). Higher demand for CCTA requires broad availability, inevitably involving smaller healthcare providers, such as non-academic hospitals and private practices. Nevertheless, most published data on CCTA image quality and safety rely on exams performed in high-volume academic centers, and little is known about CCTA in non-academic settings. Purpose To investigate the utilization of CCTA across Europe over the last decade, focusing on differences between academic and non-academic centers. Methods We included patients with stable chest pain and suspected coronary artery disease (CAD) who received CCTA and were included in the European Society of Cardiovascular Radiology MR/CT registry 01/2010–01/2020. We compared CT equipment, image quality, radiation dose, the incidence of periprocedural adverse events, patient characteristics, and CCTA findings between academic (high volume university hospitals) and non-academic centers (non-academic hospitals and private practices). Results Overall, 64,317 patients (41.2% women; age 60±13 years) from 212 sites across 19 European countries were included. Academic centers submitted most cases in 2010—2014 (51.6%), whereas non-academic centers accounted for 71.3% of records in 2015–2020. While non-academic centers used less advanced technology, radiation dose remained low (4.54 [interquartile range (IQR) 2.28–6.76] mSv) with a 30% decline of high-dose scans (&gt;7 mSv) over time. Diagnostic image quality was reported in 97.7% of cases, and the rate of acute scan-related events was low (0.4%) (Figure 1). From 2010–2014 to 2015–2020, CCTA nearly doubled in patients with low to intermediate pretest-probability, women &gt;50, and 40–60 years old men (Figure 2). CAD presence and extent decreased slightly over time (prevalence: 2010–2014: 41.5% vs. 2015–2020: 40.6%), (multi-vessel disease in those with CAD: 2010–2014: 61.9% vs. 2015–2020: 55.9%; all p&lt;0.01). Conclusion CCTA expands rapidly to non-academic centers across Europe, increasing availability while maintaining relatively low radiation dose, high diagnostic image quality, and safety. Broad availability of high-quality CCTA is essential for a successfully implementation of the recently updated guidelines for the diagnosis and management of chronic coronary syndromes. FUNDunding Acknowledgement Type of funding sources: None. Changes in CCTA utilization Changes in patient characteristics

Adverse coronary plaque characteristics are more common in patients with diabetes

Introduction Diabetes mellitus (DM) is associated with increased cardiovascular morbidity and mortality. However, there is a lack of data about the prevalence of adverse coronary artery plaques characteristics in patients with DM. Purpose In our study we aimed to compare the prevalence of adverse atherosclerotic coronary artery plaque characteristics between patients with and without DM. Methods We have analyzed the data of patients who underwent coronary computed tomography angiography (CCTA) between October 2012 and December 2020. Our exclusion criteria were coronary anomaly, congenital or other structural heart disease, previous revascularization or heart transplantation, non-diagnostic image quality and no available data on the presence of DM. Patients were divided into two groups based on the presence of DM. Results In total, 11,357 patients were included in our study. Prevalence of DM was 14.5%. There were significant differences in age (63.2±9.5 vs 58.1±12.2 years, p&lt;0.001) and major cardiovascular risk factors such as hypertension, dyslipidemia and smoking between the two groups (all p&lt;0.05). We have measured higher coronary artery calcium score in patients with DM vs. without DM (424.3±744.0 vs 174.2±794.6, p&lt;0.001). Obstructive coronary artery disease (stenosis &gt;70%) was more frequent in the DM group (24.6% vs 10.5%, p&lt;0.001). While 29.6% of patients without DM had at least one plaque with adverse characteristics, this rate was 38.9% in those with DM (positive remodeling: 19.6% vs 26.1%, low attenuation: 7.6% vs 10.2%, spotty calcium: 16.9% vs 21.6%, napkin-ring sign: 1.7% vs 2.6%, all p&lt;0.05). Conclusions The prevalence of severe coronary artery stenosis and coronary plaques with adverse characteristics was higher in patients with DM. Multivariate analysis is needed to further explore this association. FUNDunding Acknowledgement Type of funding sources: None.

Radiation Dose and Image Quality of a High-Pitch Prospective Spiral First Approach in Coronary Computed Tomography Angiography (CCTA)

Objective: To investigate a high-pitch spiral first (HPSF) approach for coronary computed tomography angiography (CCTA) in an unselected patient cohort and compare diagnostic yield and radiation exposure to CCTAs acquired via conventional, non-high-pitch spiral first (NHPSF) scan regimes. Materials and Methods: All consecutive patients from 1 January 2015 to 31 December 2017 were included. Two investigation protocols (HPSF/NHPSF) were used with the aim to achieve diagnostic image quality of all coronary segments. Low-pitch secondary scans followed the initial examination if image quality was unsatisfactory. Dosage and image quality were compared between both regimes. Results: 1410 patients were subject to a HPSF and 236 patients to a NHPSF approach. While the HPSF approach led to a higher fraction of re-scans (35% vs. 11%, p < 0.001), the fraction of aggregate scans that remained non-diagnostic after considering the initial and secondary scan was comparably low for the HPSF and NHPSF approach (0.78 vs. 0%, p = 0.18). Aggregate radiation exposure in the HPSF protocol was significantly lower (1.12 mSv (IQR: 0.73, 2.10) vs. 3.96 mSv (IQR: 2.23, 8.33) p < 0.001). Conclusions: In spite of a higher number of re-scans, a HPSF approach leads to a reduction in overall radiation exposure with diagnostic yields similar to a NHPSF approach.

Minimizing table time in patients with claustrophobia using focused ferumoxytol-enhanced MR angiography (f-FEMRA): a feasibility study

Objectives: To assess the feasibility of a rapid, focused ferumoxytol-enhanced MR angiography (f-FEMRA) protocol in patients with claustrophobia. Methods: In this retrospective study, 13 patients with claustrophobia expressed reluctance to undergo conventional MR angiography, but agreed to a trial of up to 10 min in the scanner bore and underwent f-FEMRA. Thirteen matched control patients who underwent gadolinium-enhanced MR angiography (GEMRA) were identified for comparison of diagnostic image quality. For f-FEMRA, the time from localizer image acquisition to completion of the angiographic acquisition was measured. Two radiologists independently scored images on both f-FEMRA and GEMRA for arterial and venous image quality, motion artefact and diagnostic confidence using a 5-point scale, five being best. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the aorta and IVC were measured. The Wilcoxon rank-sum test, one-way ANOVA with Tukey correction and two-tailed t tests were utilized for statistical analyses. Results: All scans were diagnostic and assessed with high confidence (scores ≥ 4). Average scan time for f-FEMRA was 6.27 min (range 3.56 to 10.12 min), with no significant difference between f-FEMRA and GEMRA in diagnostic confidence (4.86 ± 0.24 vs 4.69 ± 0.25, p = 0.13), arterial image quality (4.62 ± 0.57 vs 4.65 ± 0.49, p = 0.78) and motion artefact score (4.58 ± 0.49 vs 4.58 ± 0.28, p > 0.99). f-FEMRA scored significantly better for venous image quality than GEMRA (4.62 ± 0.42 vs 4.19 ± 0.56, p = 0.04). CNR in the IVC was significantly higher for steady-state f-FEMRA than GEMRA regardless of the enhancement phase (p < 0.05). Conclusions: Comprehensive vascular MR imaging of the thorax, abdomen and pelvis can be completed in as little as 5 min within the magnet bore using f-FEMRA, facilitating acceptance by patients with claustrophobia and streamlining workflow. Advances in knowledge: A focused approach to vascular imaging with ferumoxytol can be performed in patients with claustrophobia, limiting time in the magnet bore to 10 min or less, while acquiring fully diagnostic images of the thorax, abdomen and pelvis.

Low-count whole-body PET with deep learning in a multicenter and externally validated study

More widespread use of positron emission tomography (PET) imaging is limited by its high cost and radiation dose. Reductions in PET scan time or radiotracer dosage typically degrade diagnostic image quality (DIQ). Deep-learning-based reconstruction may improve DIQ, but such methods have not been clinically evaluated in a realistic multicenter, multivendor environment. In this study, we evaluated the performance and generalizability of a deep-learning-based image-quality enhancement algorithm applied to fourfold reduced-count whole-body PET in a realistic clinical oncologic imaging environment with multiple blinded readers, institutions, and scanner types. We demonstrate that the low-count-enhanced scans were noninferior to the standard scans in DIQ (p < 0.05) and overall diagnostic confidence (p < 0.001) independent of the underlying PET scanner used. Lesion detection for the low-count-enhanced scans had a high patient-level sensitivity of 0.94 (0.83–0.99) and specificity of 0.98 (0.95–0.99). Interscan kappa agreement of 0.85 was comparable to intrareader (0.88) and pairwise inter-reader agreements (maximum of 0.72). SUV quantification was comparable in the reference regions and lesions (lowest p-value=0.59) and had high correlation (lowest CCC = 0.94). Thus, we demonstrated that deep learning can be used to restore diagnostic image quality and maintain SUV accuracy for fourfold reduced-count PET scans, with interscan variations in lesion depiction, lower than intra- and interreader variations. This method generalized to an external validation set of clinical patients from multiple institutions and scanner types. Overall, this method may enable either dose or exam-duration reduction, increasing safety and lowering the cost of PET imaging.

Stretchable self-tuning MRI receive coils based on liquid metal technology (LiquiTune)

Magnetic resonance imaging systems rely on signal detection via radiofrequency coil arrays which, ideally, need to provide both bendability and form-fitting stretchability to conform to the imaging volume. However, most commercial coils are rigid and of fixed size with a substantial mean offset distance of the coil from the anatomy, which compromises the spatial resolution and diagnostic image quality as well as patient comfort. Here, we propose a soft and stretchable receive coil concept based on liquid metal and ultra-stretchable polymer that conforms closely to a desired anatomy. Moreover, its smart geometry provides a self-tuning mechanism to maintain a stable resonance frequency over a wide range of elongation levels. Theoretical analysis and numerical simulations were experimentally confirmed and demonstrated that the proposed coil withstood the unwanted frequency detuning typically observed with other stretchable coils (0.4% for the proposed coil as compared to 4% for a comparable control coil). Moreover, the signal-to-noise ratio of the proposed coil increased by more than 60% as compared to a typical, rigid, commercial coil.

On the way to routine cardiac MRI at 7 Tesla - a pilot study on consecutive 84 examinations

Introduction Cardiac magnetic resonance (CMR) at ultrahigh field (UHF) offers the potential of high resolution and fast image acquisition. Both technical and physiological challenges associated with CMR at 7T require specific hardware and pulse sequences. This study aimed to assess the current status and existing, publicly available technology regarding the potential of a clinical application of 7T CMR. Methods Using a 7T MRI scanner and a commercially available radiofrequency coil, a total of 84 CMR examinations on 72 healthy volunteers (32 males, age 19–70 years, weight 50–103 kg) were obtained. Both electrocardiographic and acoustic triggering were employed. The data were analyzed regarding the diagnostic image quality and the influence of patient and hardware dependent factors. 50 complete short axis stacks and 35 four chamber CINE views were used for left ventricular (LV) and right ventricular (RV), mono-planar LV function, and RV fractional area change (FAC). Twenty-seven data sets included aortic flow measurements that were used to calculate stroke volumes. Subjective acceptance was obtained from all volunteers with a standardized questionnaire. Results Functional analysis showed good functions of LV (mean EF 56%), RV (mean EF 59%) and RV FAC (mean FAC 52%). Flow measurements showed congruent results with both ECG and ACT triggering. No significant influence of experimental parameters on the image quality of the LV was detected. Small fractions of 5.4% of LV and 2.5% of RV segments showed a non-diagnostic image quality. The nominal flip angle significantly influenced the RV image quality. Conclusion The results demonstrate that already now a commercially available 7T MRI system, without major methods developments, allows for a solid morphological and functional analysis similar to the clinically established CMR routine approach. This opens the door towards combing routine CMR in patients with development of advanced 7T technology.