The disclosure relates generally to diagnostic imaging and in particular to cone beam imaging systems that have a selectable arrangement of x-ray sources for obtaining volume images of localized features and extremities.
3-D volume imaging has proved to be a valuable diagnostic tool that offers significant advantages over earlier 2-D radiographic imaging techniques for evaluating the condition of internal structures and organs, 3-D imaging of a patient or other subject has been made possible by a number of advancements, including the development of high-speed imaging detectors, such as digital radiography (DR) detectors that enable multiple images to be acquired in rapid succession.
Cone beam computed tomography (CBCT) or cone beam CT technology offers considerable promise as one type of diagnostic tool for providing 3-D volume images. Cone beam CT systems capture volumetric data sets by using a high frame rate digital radiography (DR) detector and an x-ray source, typically affixed to a gantry that rotates about the object to be imaged, directing, from each of a set of relative angular positions in its orbit around the subject, a divergent cone beam of x-rays toward the subject. The CBCT system captures projections at regular angular increments during its orbit about the subject, for example, one 2-D projection image at every degree of rotation. The projections are then reconstructed into a 3D volume image using various techniques. Among well known methods for reconstructing the 3-D volume image from the 2-D image data are filtered back projection approaches.
CBCT apparatus have considerable promise in orthopedic imaging and for related, localized imaging of extremities, such as hands, arms, legs, ankles, and knees. Portable and smaller-scale CBCT systems have been designed to allow imaging of various extremities under various conditions, including imaging of limbs in weight-bearing or elevated positions, for example. One feature of advanced CBCT systems includes configuration with multiple x-ray sources, offering the practitioner the capability to select a particular x-ray source with suitable attributes for an exam, or to utilize multiple x-ray sources in a particular imaging session.
Orthopedic applications introduce a broad range of variability, even where the same anatomy features are the subject of the CBCT imaging exam. For any particular patient, there can be a number of factors that influence the decision-making process for selecting suitable radiation conditions. The size, condition, behavior, and age of the patient, for example, may dictate the use of one type of x-ray source or another, or the use of multiple sources for enhanced resolution, for example, or may dictate the need for reduced exam timing. The particular condition of interest, required patient posture for extremity positioning or stress applied to a limb or other extremity, and other aspects of the exam can all play a role in source selection and in determining suitable technique and related parameters. In addition to number and type of x-ray sources, other features of the CBCT system itself can also be of interest, including spectral range, filter selection, number of projection images, and collimation settings, for example.
Thus, unlike many situations with conventional 2D radiography exam types, there can be a sizable number of factors to be considered in CBCT imaging, particularly for extremities. It can be appreciated that there would be value in providing utilities that streamline the decision process and thus improve workflow for CBCT imaging.
An aspect of this application is to advance the art of medical digital radiography, particularly for 3D volume imaging.
Another aspect of this application is to address, in whole or in part, at least the foregoing and other deficiencies in the related art.
It is another aspect of this application to provide, in whole or in part, at least the advantages described herein.
According to an embodiment of the present disclosure, there is provided a method comprising: a) accepting patient-specific data for imaging a patient extremity on a cone beam computed tomography apparatus; b) generating and displaying, according to the patient-specific data, a set of acquisition parameters and a dose indication for 2-D projection image capture of the extremity on the cone beam computed tomography apparatus; d) updating the generated set of acquisition parameters and dose indication according to one or more operator-entered instructions; e) acquiring a set of 2-D projection images of a 3-D volume that includes the patient extremity according to the updated set of acquisition parameters; f) reconstructing the 3-D volume according to the acquired set of 2-D projection images; and g) displaying, storing, or transmitting the reconstructed 3-D volume.
These objects are given only by way of illustrative example, and such objects may be exemplary of one or more embodiments of the invention. Other desirable objectives and advantages inherently achieved by the disclosed invention may occur or become apparent to those skilled in the art. The invention is defined by the appended claims.
The foregoing and other objects, features, and advantages of the invention will be apparent from the following more particular description of the embodiments of the invention, as illustrated in the accompanying drawings. The elements of the drawings are not necessarily to scale relative to each other.
The following is a description of exemplary embodiments of the invention, examples of which are illustrated in the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts.
For illustrative purposes, principles of the invention are described herein by referring mainly to exemplary embodiments thereof. However, one of ordinary skill in the art would readily recognize that the same principles are equally applicable to, and can be implemented in, all types of radiographic imaging arrays, various types of radiographic imaging apparatus and/or methods for using the same and that any such variations do not depart from the true spirit and scope of the application. Moreover, in the following description, references are made to the accompanying figures, which illustrate specific exemplary embodiments. Electrical, mechanical, logical and structural changes can be made to the embodiments without departing from the spirit and scope of the invention.
In the context of the application, the term “extremity” has its meaning as conventionally understood in diagnostic imaging parlance, referring to knees, legs, ankles, fingers, hands, wrists, elbows, arms, and shoulders and any other anatomical extremity. The term “subject” is used to describe the extremity of the patient that is imaged, such as the “subject leg”, for example. The term “paired extremity” is used in general to refer to any anatomical extremity wherein normally two or more are present on the same patient. In the context of the application, the paired extremity is not imaged unless necessary; only the subject extremity is imaged. In one embodiment, a paired extremity is not imaged to reduce patient dose.
A number of the examples given herein for extemporary embodiments of the application focus on imaging of the load-bearing lower extremities of the human anatomy, such as the leg, the knee, the ankle, and the foot, for example. However, these examples are considered to be illustrative and non-limiting.
In the context of the application, the term “arc” or, alternately, or arcuate has a meaning of a portion of a curve, spline or non-linear path, for example as being a portion of a curve of less than or greater than 360 degrees.
The term “actuable” has its conventional meaning, relating to a device or component that is capable of effecting an action in response to a stimulus, such as in response to an electrical signal, for example.
As used herein, the term “energizable” relates to a device or set of components that perform an indicated function upon receiving power and, optionally, upon receiving an enabling signal.
CT and CBCT systems are known apparatus used for volume imaging in dental and medical applications. An exemplary medical cone beam CT (CBCT) imaging system is the Carestream OnSight3D Extremity System from Carestream Health, Rochester, N.Y. Reference is made to commonly assigned U.S. Pat. No. 8,348,506 (Yorkston) entitled “EXTREMITY IMAGING APPARATUS FOR CONE BEAM COMPUTED TOMOGRAPHY” and to U.S. Pat. No. 9,949,703 (DiRisio) entitled “EXTREMITY IMAGING APPARATUS”, both incorporated herein by reference in their entirety.
A full 360-degree orbit of the source and detector is not needed for conventional CBCT imaging; instead, sufficient information for image reconstruction can be obtained with an orbital scan range that just exceeds 180 degrees by the angle of the cone beam itself, for example. However, in some cases it can be difficult to obtain much more than about 180-degree revolution for imaging the knee or other joints. Moreover, there can be diagnostic situations in which obtaining projection images over a certain range of angles has advantages, but patient anatomy blocks the source, detector, or both from imaging over that range. Some of the proposed solutions for obtaining images of extremities under these conditions require the patient to assume a position that is awkward or uncomfortable. The position of the extremity, as imaged, is not representative of how the limb or other extremity serves the patient in movement or under weight-bearing conditions. It can be helpful, for example, to examine the condition of a knee or ankle joint under the normal weight load exerted on that joint by the patient as well as in a relaxed position. But, if the patient is required to assume a position that is not usually encountered in typical movement or posture, there may be excessive strain, or insufficient strain, or poorly directed strain or tension, on the joint. The knee or ankle joint, under some artificially applied load and at an angle not taken when standing, may not behave exactly as it does when bearing the patient's weight in a standing position. Images of extremities under these conditions may fail to accurately represent how an extremity or joint is used and may not provide sufficient information for assessment and treatment planning. The perspective and corresponding top view of
The limiting geometry for image capture is due to the arc of source transport 32 blocked by patient anatomy, such as by a paired limb), and thus limited typically to less than about 220 degrees, as noted previously. The circumferential gap, or opening, or housing gap, or peripheral gap 38 exists between the endpoints of the arc of source path 26, between ends of a C-shaped transport mechanism, or between ends of a C-shaped scanner housing as described herein. Gap or opening 38 provides space for the patient to stand, for example, while one leg is being imaged. It also provides access through the gap for positioning a patient extremity by moving the patient extremity through the gap in a direction substantially perpendicular to the axis β without requiring the extremity extended through one end of the bore opening.
Detector path 28 can extend across housing gap 38 to allow scanning, since the detector is not necessarily blocked by patient anatomy and can have a detector travel path extending between a patient's extremities and at least partially around an imaged extremity. Embodiments of the present invention allow clearance of the housing gap by moving away a housing extension, or door, and scanning components, as explained herein, to allow access for the patient as part of initial patient positioning. The perspective view in
This patient access and subsequent adjustment of detector transport 34 is shown in successive stages 42, 44, and 46 in
Circumferential gap or opening 38 not only allows access for positioning of a subject's leg or other extremity, but also allows sufficient space for the patient to stand in normal posture during imaging, placing the subject leg for imaging in the central position along axis β. (
By way of example, the top views of
Given this basic operation sequence in which the source 22 and detector 24 orbit the subject extremity, the usefulness of an imaging system that is adaptable for imaging patient extremities with the patient sitting or standing and in load-bearing or non load-bearing postures can be appreciated. The perspective view of
According to portable CBCT embodiments such as shown in
As the various embodiments shown in
The perspective view of
For example, examination for a body part of moderate size, such as a hand, requires only a small volume for scanning, so that sufficient images for reconstruction can be obtained using a single x-ray source. Conversely, an examination where limb dimensions extend over a significant length can be more compatible for imaging of the volume using multiple sources.
In some cases, there can be factors that conflict in some ways, such as for imaging that is most favorable with higher resolution, but where low dose should be used.
Recognizing the inherent complexities of orthopedic imaging and the need for more efficient workflow and a streamlined decision-making process, the Applicants have developed an approach for automated assistance with orthopedic imaging setup when using portable CBCT extremity imaging apparatus.
The logic flow diagram of
The patient-specific data and clinical parameters acquired in step S710 provide a basis of information that guides selection logic for an automated parameters generation step S720, in which acquisition and reconstruction parameters suitable for the input parameters are generated. A display step S730 then shows the computed acquisition and reconstruction parameters that have been generated for the patient. Generating acquisition parameters can include selecting one set of parameters from a library having multiple sets, each with recommended parameter settings, previously generated and stored, for example. An override decision step S740 gives the operator or practitioner the option to review and accept or override the generated parameters and enter alternate values for projection image acquisition and reconstruction options. Where the operator selects to override one or more parameters, an update step S750 executes, accepting operator instructions for alternative acquisition or reconstruction parameters and returning to display step S730 with the updated values. Where no further override is needed, a scan enable step S760 then enables the CBCT scan capability using the obtained set of parameters. An acquisition and reconstruction step S770 then performs the required processing for acquisition of a set of 2-D projection images of the volume, and reconstruction of the 3-D volume from the set of 2-D images for display, storage, or transmission.
As shown in the
(i) Anatomy to be imaged. The subject or region of interest for a CBCT reconstruction can determine what default conditions apply for initial image capture and subsequent processing.
(ii) Clinical task. The clinical task relates to the particular features of interest from the exam. These can be features of particular bone detail, such a fracture or particular trabecular structure. Soft tissue contrast may be of interest. Alternately, imaging of implants or other hardware can be of interest, such as to evaluate healing, aging, or loosening or degradation, for example.
(iii) Image quality target. Target values for image quality can vary according to the anatomy and clinical task, as outlined previously. There can also be factors such as confidence level that apply for a particular image type.
(iv) Patient descriptors. Patient-specific data that are factors related to image acquisition for the individual patient and can include relative size of the patient or extremity, including relative size of the body part that is to be imaged (small/medium/large or other relative indication), patient condition, patient age, and weight, for example. The individual patient's state of agitation can also be a factor affecting operating options selection, such as suggesting difficulties the particular patient may be having due to pain or due to difficulties with sitting still or remaining in a fixed position for a suitable length of time.
(v) Acquisition speed. The speed of image acquisition can relate to the patient's state of agitation, as just noted, or to urgency or other factors.
(vi) Reconstruction options. Reconstruction options can include overall reconstruction speed, correction for metal content or for patient motion, or factors that relate to selection of a suitable reconstruction protocol.
A set of acquisition parameters can be generated automatically from the input parameters obtained in step S710 of the
(i) Angular range. As was shown in
(ii) Angular resolution. Depending on the type of exam and needed reconstruction quality, there can be some allowance provided for adjusting the size of the angular increments between captured projection images.
(iii) ROI selection. The selection of an appropriate region of interest (ROI) can be obtained from a scout image, for example. A scout image is acquired separately from the projection images and can be analyzed to detect an ROI using techniques familiar to those skilled in the imaging arts. This selection can be used to designate a suitable combination of one or more x-ray sources, as described previously with reference to
(iv) X-ray source allocation and conditioning. Along with the number of x-ray sources that are used, acquisition parameters can include data on the number of projections per x-ray source, as well as various technique parameters, including mA/ms per x-ray source, kVp per source, mA/kVp modulation, spectral CT per x-ray source (for example kV switching, filter switching), and filter selection, which can also be varied per x-ray source.
(v) Collimation settings. Where multiple sources are used, collimator settings can differ or can be the same for each source.
(vi) Detector binning mode. Detector binning can be used as a factor in the trade-off between resolution and speed, for example.
(vii) Source/detector trajectory. This can include alterations to the standard gantry arrangement or travel pattern where permitted by the CBCT system.
(viii) Speed. The gantry orbital speed may be adjustable in some embodiments.
(ix) Firing order. Where two or more x-ray sources are selected, the firing order can be adjusted for energizing the sources in a desired sequence.
(x) Number of projections. This value can be computed by the system according to the angular increment and range, as specified above. Alternately, the number of projections can be modified directly by the operator, thereby adjusting the angular increment or range, or both angular increment and range.
(xi) Dual-energy. Dual energy imaging can be specified, with appropriate setup for each cooperating energy channel. Selection of dual-energy imaging can automatically set a number of acquisition variables to default values.
Reconstruction parameters calculated for the input parameters can include any of the following:
(i) Voxel dimensions.
(ii) Reconstruction volume size.
(iii) Reconstruction algorithm used. The system may default to one type of reconstruction algorithm but allow the operator to designate some other type for a particular case. Reconstruction can use an analytical method, such as filtered back projection (FBP) or FDK (Feldkamp, Davis and Kress) reconstruction, or can employ an iterative algebraic or statistical reconstruction technique, for example.
(iv) Reconstruction parameters. The system may generate a default set of reconstruction parameters for the given anatomy or may compute reconstruction parameters appropriate for the exam type. Various types of reconstruction parameter can include variables specifying levels of denoising, regularization, and number of iterations, for example.
Default or computed parameter settings can be displayed to the operator in step S730 of
By way of example
Continuing with the
A dose indicator 92 shows a computed dose value for the given parameters. This value can be a numeric value, such as in milliSieverts (mSv) or some other indication (low/medium/high) and may be initially obtained using a scout image. According to an embodiment, the dose level is adjustable; the
Overrides such as those depicted in
Consistent with one embodiment, the present invention utilizes a computer program with stored instructions that perform on image data accessed from an electronic memory. As can be appreciated by those skilled in the image processing arts, a computer program of an embodiment of the present invention can be utilized by a suitable, general-purpose computer system, such as a personal computer or workstation. However, many other types of computer systems can be used to execute the computer program of the present invention, including networked processors. The computer program for performing the method of the present invention may be stored in a computer readable storage medium. This medium may comprise, for example; magnetic storage media such as a magnetic disk such as a hard drive or removable device or magnetic tape; optical storage media such as an optical disc, optical tape, or machine-readable bar code; solid state electronic storage devices such as random-access memory (RAM), or read only memory (ROM); or any other physical device or medium employed to store a computer program. The computer program for performing the method of the present invention may also be stored on computer readable storage medium that is connected to the image processor by way of the internet or other communication medium. Those skilled in the art will readily recognize that the equivalent of such a computer program product may also be constructed in hardware.
It should be noted that the term “memory”, equivalent to “computer-accessible memory” in the context of the present disclosure, can refer to any type of temporary or more enduring data storage workspace used for storing and operating upon image data and accessible to a computer system, including a database. The memory could be non-volatile, using, for example, a long-term storage medium such as magnetic or optical storage. Alternately, the memory could be of a more volatile nature, using an electronic circuit, such as random-access memory (RAM) that is used as a temporary buffer or workspace by a microprocessor or other control logic processor device. Displaying an image requires memory storage. Display data, for example, is typically stored in a temporary storage buffer that is directly associated with a display device and is periodically refreshed as needed in order to provide displayed data. This temporary storage buffer can also be considered to be a memory, as the term is used in the present disclosure. Memory is also used as the data workspace for executing and storing intermediate and final results of calculations and other processing. Computer-accessible memory can be volatile, non-volatile, or a hybrid combination of volatile and non-volatile types.
It will be understood that the computer program product of the present invention may make use of various image manipulation algorithms and processes that are well known. It will be further understood that the computer program product embodiment of the present invention may embody algorithms and processes not specifically shown or described herein that are useful for implementation. Such algorithms and processes may include conventional utilities that are within the ordinary skill of the image processing arts. Additional aspects of such algorithms and systems, and hardware and/or software for producing and otherwise processing the images or co-operating with the computer program product of the present invention, are not specifically shown or described herein and may be selected from such algorithms, systems, hardware, components and elements known in the art.
The invention has been described in detail with particular reference to a presently preferred embodiment, but it will be understood that variations and modifications can be effected within the spirit and scope of the invention. The presently disclosed embodiments are therefore considered in all respects to be illustrative and not restrictive. The scope of the invention is indicated by the appended claims, and all changes that come within the meaning and range of equivalents thereof are intended to be embraced therein.