Patent Application
20130089186
This disclosure relates generally to an x-ray calibration device that may be used for validating visceral adipose tissue (VAT) measurements.
Characteristics of an individual, such as body weight, fat mass, height, girth, gender, age, etc. are clinical descriptors useful by physicians to predict certain health risks that may increase or decrease mortality and morbidity risk. For example, the amount or type of abdominal fat, such as subcutaneous adipose tissue (SAT) or visceral adipose tissue (VAT), are associated with, and useful predictors of, an adverse metabolic risk profile and certain diseases, such as coronary heart disease and diabetes. In addition, measuring visceral adipose tissue, for example, can relate to metabolic syndrome (i.e., a combination of medical problems that can increase the risk of heart disease and/or diabetes). People suffering from metabolic syndrome can have some or all of the following: high blood glucose, high blood pressure, abdominal obesity, low high-density lipoprotein (HDL) cholesterol, high low-density lipoprotein (LDL) cholesterol, high total cholesterol and/or high triglycerides.
Conventional methods and systems for measuring VAT are mostly performed using anthropomorphic gauges, bioimpedance gauges, weight scales, etc. These devices often are not capable of providing accurate measurements of VAT because the actual fat content is not being measured, certain assumptions/estimates are made during the calculation process, and/or the devices are not exactly calibrated. Also, reproducibility may be difficult, leading to inaccurate comparisons between examinations.
Medical diagnostic imaging systems have also been used to measure VAT content. However, the use of these systems are often costly and can expose a patient to high levels of ionizing radiation, for example, when using a computed tomography (CT) imaging system. Additionally, these imaging systems are not always available for clinical use and may have long scan times. Moreover, certain measurements are inaccurate in larger individuals.
Conventional methods and systems for determining VAT often also use simple models to approximate the abdominal cavity from an estimate of subcutaneous fat thickness measurements. However, these methods and systems often fail to accurately estimate SAT, thereby resulting in an inaccurate estimate of VAT. For example, a normal dual-energy X-ray absorptiometry (DXA) image of the abdomen is a planar two-dimensional (2D) image that cannot explicitly measure VAT because it cannot measure the thickness of SAT in the vertical plane. It has been very difficult to determine the thickness of the subcutaneous fat layer around the abdomen, especially near the buttocks, since the models used in the past do not take into account differences in the thickness of the subcutaneous fat layer around the abdomen near the buttocks.
It has been determined that VAT may be estimated based on a model used in combination with data acquired with a DXA system. However, it is still desirable to have an x-ray calibration device for validating the VAT measurements obtained with specific DXA systems. Additionally, it is desirable to have an x-ray calibration device that may be used for cross-calibration studies correlating VAT measurements obtained with a CT system and VAT estimates obtained with a DXA system. Data from cross-calibration studies between DXA and CT systems may, for instance, be used to modify the model or algorithm used for estimating VAT with a DXA system or to verify the performance of new models and/or algorithms. Since performing scans on live patients would expose the patients to unnecessary x-ray dose, particularly with respect to cross-calibration studies using CT data, there is a need for an x-ray calibration device that models the abdomen of a patient for the purpose of determining VAT measurements.
In accordance with an aspect of the disclosure, an x-ray calibration device includes a core including a first material with a first x-ray attenuation coefficient, the core defining a cavity that is configured to receive a plug of a different x-ray attenuation coefficient in order to alter the x-ray attenuation coefficient of the x-ray calibration device. The x-ray calibration device also includes an outer layer at least partially surrounding the core, the outer later comprising a second material with a second x-ray attenuation coefficient, where the second x-ray attenuation coefficient is lower than the first x-ray attenuation coefficient.
In accordance with an aspect of the disclosure, an x-ray calibration device includes a core assembly including an adjustable material that may be adjusted to provide multiple x-ray attenuation coefficients. The x-ray calibration device also includes an outer layer circumscribing the core assembly, the outer layer having an x-ray attenuation coefficient that is lower than the core assembly.
In accordance with an aspect of the disclosure, an x-ray calibration device includes a core with a generally cylindrical shape, the core including a first material with an x-ray attenuation coefficient generally equivalent to lean body tissue. The core defines two cavities. The x-ray calibration device includes an outer layer circumscribing the core, the outer layer including a second material with an x-ray attenuation coefficient generally equivalent to adipose. The x-ray calibration device includes a first plurality of plugs shaped to fit in the two cavities, wherein the first plurality of plugs include a first material with a first x-ray attenuation coefficient. The x-ray calibration device includes a second plurality of plugs shaped to fit in the two cavities, wherein the second plurality of plugs include a second material with a second x-ray attenuation coefficient. The x-ray attenuation coefficient of the x-ray calibration device may be adjusted based on the combination of the first plurality of plugs and the second plurality of plugs that are inserted into the two cavities.
Various other features, aspects, and advantages will be made apparent to those skilled in the art from the accompanying drawings and detailed description thereof.
Referring now to the drawings,
The image 20 allows for the identification of different portions or regions of interest in the imaged body. For example, an android region 22 of the imaged body can be determined using the image 20. For example, based on tissue information of the imaged body, the android region 22 can be identified and the visceral adipose tissue mass thereof estimated or calculated using the acquired tissue information. A lower boundary 24 and an upper boundary 26 of the android region 22 may be determined and identified using information acquired during the dual-energy X-ray scan, including the image 20 and tissue information, including fat and lean tissue information. The android region 22 generally corresponds to the abdominal region or abdomen of a subject.
In general, the image 20 formed from the dual-energy X-ray imaging system is a two-dimensional (2D) image of a three-dimensional (3D) body. In particular, the image 20 is an anterior-posterior (AP) image of a body acquired using a dual-energy X-ray imaging system. The image 20 may also be referred to as a posterior-anterior (PA) image of the body. The dual-energy X-ray imaging system may be used to acquire both bone and tissue information (particularly soft tissue information) from one or more projection measurements of X-ray attenuation at two different X-ray energy ranges. For example, when a subject is lying down on a table between an X-ray source below the subject and an X-ray detector above the subject (or vice versa), the X-ray detector can obtain information for a dual-energy X-ray absorptiometry (DXA) AP view of the composition of the body, including tissue, as well as the spine, bones or portions thereof as a result of the passage of X-rays at two different energy levels through the subject. In an exemplary embodiment, the subject may be a human patient (i.e., a patient), an animal or an object.
The dual-energy X-ray imaging system 30 includes a table 32 providing a horizontal surface for supporting a subject 34, for example a patient, in a supine or lateral position along a longitudinal axis 36. The dual-energy X-ray imaging system 30 also includes an imaging assembly 38, for example, such as a C-arm. The imaging assembly 38 includes a lower arm 40 that is positioned beneath the table 32 and supports an X-ray source 42 positioned at one end thereof. The imaging assembly 38 also includes an upper arm 44 that is positioned above the table 32 and supports an X-ray detector 46 at one end thereof. The imaging assembly 38 is configured such that the lower arm 40 and the upper arm 44 are coupled together so that the X-ray source 42 and the X-ray detector 46 move in unison with each other. However, it should be noted that the position of the X-ray source 42 and the X-ray detector 46 may be reversed. The X-ray detector 46 may be fabricated, for example, as a multi-element cadmium-zinc-telluride (CZT) detector providing for energy discrimination. The X-ray source 42 and the X-ray detector 46 may be moved in a transverse raster pattern 48 so as to trace a series of transverse scans 50 of the subject 34, where the X-ray source 42 and the X-ray detector 46 move from side-to-side, perpendicular to longitudinal axis 36, along the entire length of the subject 34, during which dual-energy X-ray imaging data is collected by the X-ray detector 46. Dual-energy X-ray imaging data is collected only during transverse (side-to-side) movement of the X-ray source 42 and the X-ray detector 46. The transverse raster pattern is produced by actuators (not shown) under control of a translation controller 52. During operation, the X-ray source 42 produces an X-ray fan beam 54 in a plane that is parallel to the longitudinal axis 36. However, in some embodiments, the X-ray fan beam 54 may be provided in a plane that is perpendicular to the longitudinal axis 36. The transverse raster pattern 48 is adjusted in some embodiments such that there is some overlap (e.g., slight overlap of approximately 10 percent) between successive transverse scans 50 of the X-ray fan beam 54.
In other dual-energy X-ray imaging systems, the X-ray source and the X-ray detector may be moved in a longitudinal raster pattern so as to trace a series of longitudinal scans of the subject, where the X-ray source and the X-ray detector move from head to feet and vice versa, parallel to the longitudinal axis along the entire length of the subject.
The X-ray source 42, the X-ray detector 46, and the translation controller 52 communicate with and are under the control of a computer 60 which may include both dedicated circuitry and one or more processors having the ability to execute a stored program, for example, instructions for computer 60 that are stored in memory or in software. In an exemplary embodiment, the computer 60 also includes a body fat measurement module 70. The body fat measurement module 70 utilizes the dual-energy X-ray image data, and in particular, the acquired tissue and bone information to determine an amount of visceral adipose tissue, and more particularly, abdominal visceral adipose tissue of a scanned body of the subject 34. During operation, the body fat measurement module 70 directs the dual-energy X-ray imaging system 30 to acquire a scan of a portion of the body or a full body (or total body scan), from which tissue information as well as bone information may be identified. The locations of bone landmarks may be determined automatically, manually or semi-automatically, for example, with an operator adjusting automatically generated landmarks and used to identify regions of interest of the imaged body.
The body fat measurement module 70 may then utilize the dual-energy X-ray image data, including the acquired tissue information, particularly, soft tissue information, and bone information to determine the visceral adipose tissue mass in one or more regions of interest of the subject. In various embodiments, using tissue and bone information or measurements in combination with different methods or models, abdominal visceral adipose tissue may be determined. It should be noted that different landmarks may be used to identify one or more regions of interest for which the visceral adipose tissue mass is to be determined. It also should be noted that different methods or models may be used to determine the visceral adipose tissue mass in different sections of the 2D planar image(s) from the dual-energy X-ray imaging system 30. It further should be noted that although the various embodiments are described in connection with a dual-energy X-ray imaging system, the various embodiments are not limited to a dual-energy X-ray imaging system or a particular configuration thereof.
Referring again to
During operation, the dual-energy X-ray imaging system 30 may be configured to operate in either a dual-energy X-ray mode or a single energy X-ray mode. In the single energy X-ray mode, the X-ray source 42 emits X-rays in a narrow band of energies of a few keV and in the diagnostic imaging range of approximately 20-150 keV. In the dual-energy X-ray mode, the X-ray source 42 emits radiation in two or more bands of energy emitted simultaneously or in rapid succession. The X-ray source 42 may also be configured to emit a single broadband of energy of more than a few keV over the diagnostic imaging range. The dual-energy X-ray imaging system 30 may be switched between the dual-energy X-ray mode and the single energy X-ray mode by increasing or decreasing the X-ray source 42 voltage and/or current. The dual-energy X-ray imaging system 30 may also be switched between the dual-energy X-ray mode and the single energy X-ray mode by removing or adding a K-edge filter. It should be noted that the X-ray source 42 may emit X-rays at different energies or ranges of energies.
The X-ray source 42 may be configured to output a fan beam of X-rays 54 as shown in
Various embodiments provide for calculating or estimating the visceral adipose tissue mass of one or more different portions or regions of a subject. The tissue and bone information used for calculating the visceral adipose tissue mass is acquired in the various embodiments using a one or more dual-energy X-ray scans. For example, region specific X-ray scans may be performed where only a potion or region of the subject 34 (e.g., the abdominal region) is scanned for use in calculating the visceral adipose tissue mass. In other embodiments, a full body or total body X-ray scan is performed.
Visceral adipose tissue (VAT) measurements, such as those performed with either a CT system or a DXA system are attempting to determine the level of visceral adipose of a patient. The subcutaneous layer of fat is typically not included in a VAT measurement. As previously discussed, the cost and dose associated with each CT scan do not make CT a good option for VAT measurements. However, the cost and dose of DXA scans are lower than the cost and dose for CT scans.
The x-ray calibration device 300 is shaped to model the abdomen of a typical patient. According to an exemplary embodiment, the x-ray calibration device 300 may be approximately 20 cm in length.
The outer layer 304 surrounds the core 302. The outer layer 304 is made of a material with an x-ray attenuation coefficient equivalent to the layer of subcutaneous fat surrounding the abdominal region of a typical patient. According to an exemplary embodiment, the outer layer 304 may comprise a material with an x-ray attenuation coefficient equivalent to a range of 70-90% fat as measure on a DXA system. The outer layer 304 circumscribes the core 302, as is shown in
The outer layer 304 that surrounds the core 302 has a uniform thickness according to the embodiment shown in
As previously described, the x-ray calibration device 300 defines four cavities: the first cavity 306, the second cavity 308, the third cavity 310, and the fourth cavity 312. According to an embodiment, the first cavity 306 and the second cavity 308 may both be the same shape. For example, they may both be a cylindrical shape of a first diameter. The third cavity 310 may also be the same size and shape as the fourth cavity 312. According to an embodiment, they may both be a cylinder of a second diameter that is smaller than the first diameter. All four cavities 306, 308, 310, and 312 may have a generally constant cross section for the length of the x-ray calibration device 300. Each of the cavities 306, 308, 310, and 312 may be configured to receive a plug. The cavities may be open-ended cavities in order to facilitate the easy insertion and removal of various plugs. Additional details about the cavities and the plugs will be described in detail hereinafter.
The x-ray calibration device 300 may be used as a phantom for validating VAT measurements obtained at a multiple visceral adipose tissue compositions. In other words, the x-ray calibration device 300 may be scanned when performing a VAT measurement. As described with respect to
The x-ray calibration device 300 is well-suited for validating VAT measurements obtained with either a DXA system or a CT system for several reasons. First, the x-ray calibration device 300 models visceral tissue accurately enough to be useful as a phantom; the x-ray calibration device 300 is generally shaped like the abdomen of a patient. Second, the outer layer 304 of the x-ray calibration device 300 represents the subcutaneous layer of fat, just like what would be found on a typical patient. Therefore, the x-ray calibration device 300 may be used to confirm that a particular VAT estimation algorithm accurately accounts for subcutaneous fat. Third, since the plugs of the x-ray calibration device 300 are adapted to be easily and quickly switched out for plugs of different x-ray attenuation coefficients, the overall x-ray attenuation of the x-ray calibration device 300 may be quickly adjusted to represent a variety of known adipose levels. The user may, therefore, use the x-ray calibration device 300 to confirm CT VAT measurements and DXA VAT measurements at multiple adipose levels.
Other embodiments may be shaped differently than the embodiments shown in
While the disclosure has been described with reference to various embodiments, those skilled in the art will appreciate that certain substitutions, alterations and omissions may be made to the embodiments without departing from the spirit of the disclosure. Accordingly, the foregoing description is meant to be exemplary only, and should not limit the scope of the disclosure as set forth in the following claims.
